Focal Spinal Epidural Lipomatosis After a Single Epidural Steroid Injection

Danielson, Kirk; Harrast, Mark A.

doi:10.1016/j.pmrj.2010.11.009

Cited by 15 publications

(41 citation statements)

References 8 publications

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“…Case reports have also presented other complications including iatrogenic Cushing’s syndrome [ 131 , 166 ], persistent hiccups [ 128 , 152 ], convulsions [ 129 ], reversible posterior leukoencephalopathy syndrome [ 82 ], epidural granuloma formation [ 150 ], subdural block [ 157 ], Brown–Séquard syndrome [ 159 ], herpes zoster outbreak [ 165 ], steroid myopathy [ 166 ] and corticosteroid-induced psychosis [ 137 ] following ESI. Spinal epidural lipomatosis is a rare condition of adipose tissue hypertrophy in the epidural space and has been reported to occur after ESI [ 138 , 143 , 161 ]. In addition, cardiopulmonary arrest following ESI and anaphylaxis and other adverse events due to the epidural corticosteroid compounds can occur [ 134 , 136 , 149 , 169 , 175 ].…”

Section: Resultsmentioning

confidence: 99%

Safety of Epidural Corticosteroid Injections

et al. 2015

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Background and ObjectiveEpidural corticosteroid injections (ESIs) have been used for several decades and now represent the most common intervention performed for the management of back pain with a radicular component. However, several reports have presented devastating complications and adverse effects, which fuelled concerns over the risk versus clinical effectiveness. The authors offer a comprehensive review of the available literature and analyse the data derived from studies and case reports.MethodsStudies were identified by searching PubMed MEDLINE, Ovid MEDLINE, EMBASE, Scopus, Google Scholar and the Cochrane Library to retrieve all available relevant articles. Publications from the last 20 years (September 1994 to September 2014) were considered for further analysis. Studies selected were English-language original articles publishing results on complications related to the technique used for cervical and lumbar ESIs. The studies had to specify the approach used for injection. All studies that did not fulfil these eligibility criteria were excluded from further analysis.ResultsOverall, the available literature supports the view that serious complications following injections of corticosteroid suspensions into the cervical and lumbar epidural space are uncommon, but if they occur they can be devastating.ConclusionsThe true incidence of such complications remains unclear. Direct vascular injury and/or administration of injectates intra-arterially represent a major concern and could account for the vast majority of the adverse events reported. Accurate placement of the needle, use of a non-particulate corticosteroid, live fluoroscopy, digital subtraction angiography, and familiarisation of the operator with contrast patterns on fluoroscopy should minimise these risks. The available literature has several limitations including incomplete documentation, unreported data and inherent bias. Large registries and well-structured observational studies are needed to determine the true incidence of adverse events and address the safety concerns.

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Section: Resultsmentioning

confidence: 99%

Safety of Epidural Corticosteroid Injections

et al. 2015

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“…However, there is a theoretical risk of worsening SEL with this procedure. Six cases of symptomatic lumbosacral SEL following epidural injection in patients with minimal to no prior SEL on imaging have been reported [39,[44][45][46][47]. McCullen et al describe the development of symptomatic SEL in a patient after 8 epidural steroid injections within two years, including 5 within 3 months for lumbosacral radiculitis.…”

Section: Discussionmentioning

confidence: 99%

Transforaminal epidural steroid injection in the treatment of lumbosacral radicular pain caused by epidural lipomatosis: A case series and review

McCormick

Plastaras

2014

BMR

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“…ESI have also been hypothesized to exacerbate epidural lipomatosis in some circumstances which could exacerbate spinal stenosis in the long term. 22, 23 Another possible explanation is that the ESI may temporarily mask protective painful stimuli and otherwise disinhibit patients who would be limited by pain. Thus ESIs may temporarily diminish pain, but may actually potentiate damage to the nerve roots in the long term which ultimately diminishes clinical outcomes even after a successful decompression operation.…”

Section: Discussionmentioning

confidence: 99%

Epidural Steroid Injections Are Associated With Less Improvement in Patients With Lumbar Spinal Stenosis

Radcliff

Kepler

Hilibrand

et al. 2013

Spine

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Summary of Background Data Lumbar spinal stenosis is a common incidental finding among adults over the age of 60, The use of ESI in these patients is common, although there is little evidence in the literature to demonstrate the long-term benefit of ESI in the treatment of lumbar stenosis. Objective The hypothesis of this study was that patients who received epidural steroid injections (ESI) during initial treatment as part of the Spine Patient Outcomes Research Trial (SPORT) would have improved clinical outcomes and a lower rate of crossover to surgery compared to patients who did not receive ESI. Methods Patients with lumbar spinal stenosis who received epidural steroid injections within the first three months of enrollment in SPORT (ESI) were compared to patients who did not receive epidural injections during the first three months of the study (No ESI). Results There were 69 ESI patients and 207 No-ESI patients. There were no significant differences in demographic factors, baseline clinical outcome scores, or operative details although there was a significant increase in baseline preference for nonsurgical treatment among ESI patients (62% vs. 33%, p <0.001). There was an average 26 minute increase in operative time and an increased length of stay by 0.9 days among the ESI patients who ultimately underwent surgical treatment. Averaged over four years, there was significantly less improvement in SF36 PF among surgically treated ESI patients (ESI 14.8 vs. No-ESI 22.5, p=0.025). In addition, there was also significantly less improvement among the nonsurgically treated patients in SF36 BP (ESI 7.3 vs. No-ESI 16.7, p=0.007) and SF36 PF (ESI 5.5 vs. No-ESI 15.2, p=0.009). Of the patients assigned to surgical treatment, there was a significantly increased crossover to nonsurgical treatment among patients who received an ESI (ESI 33% vs. No ESI 11%, p=0.012). Of the patients assigned to non-operative treatment, there was a significantly increased crossover to surgical treatment in the ESI patients (ESI 58% vs. No ESI 32%, p=0.003). Conclusion Despite equivalent baseline status, ESI were associated with significantly less improvement at four years among all patients with spinal stenosis in SPORT. Furthermore, ESI were associated with longer duration of surgery and longer hospital stay. There was no improvement in outcome with ESI whether patients were treated surgically or nonsurgically.

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Focal Spinal Epidural Lipomatosis After a Single Epidural Steroid Injection

Cited by 15 publications

References 8 publications

Safety of Epidural Corticosteroid Injections

Safety of Epidural Corticosteroid Injections

Transforaminal epidural steroid injection in the treatment of lumbosacral radicular pain caused by epidural lipomatosis: A case series and review

Epidural Steroid Injections Are Associated With Less Improvement in Patients With Lumbar Spinal Stenosis

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