PAINFUL RADICULOPATHY treated with EPIDURAL INJECTIONS OF PROCAINE AND HYDROCORTISONE ACETATE

Hw, Goebert; Sj, Jallo; Wj, Gardner; Ce, Wasmuth

doi:10.1213/00000539-196101000-00017

Cited by 96 publications

(52 citation statements)

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“…Degenerative lumbar spinal stenosis is a common disease in the elderly population, which is rapidly increasing (5). However, in most cases, the initial clinical symptoms and imaging findings are nonspecific, discordant or insufficient for diagnosis (6)(7)(8)(9). In addition, some patients complain about multi-level radiculopathy.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Therapeutic Effect between a Transforaminal along with a Caudal Epidural Injection, as Well as Two-Level Transforaminal Epidural Injections in a Radiculopathy Patient

Hwang

Cho

et al. 2017

J Korean Soc Radiol

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Purpose:The aim of this study was to evaluate the therapeutic effect of a transforaminal epidural steroid injection (TFESI) along with a caudal epidural steroid injection (ESI), compared to two-level TFESIs in a multi-level radiculopathy patient. Materials and Methods: A total of 895 lumbar ESIs were performed in 492 patients with multi-level radiculopathy from January 2012 to January 2015. Before injections were performed, the initial Numeric Rating Scale (NRS) score was assessed in all patients, categorized into no pain (excellent), mild (good, NRS: 1-3), moderate (fair, NRS: 4-6), and severe pain (poor, NRS: 7-10). Therapeutic effects were examined for two groups: one-level TFESI along with caudal and ESI two-level TFESIs. Patient outcomes were assessed by NRS in a serial follow-up at one, three, and six months. Results: One TFESI along with caudal ESI was performed in 274 patients and two TFESIs for 218. For the former group with one TFESI along with caudal ESI, excellent results were shown: 219 (79.9%) patients after one month, 200 (72.9%) after three, and 193 (70.4%) after six months. In the patient group with two TFESIs (n = 218) the outcomes were also very good: 152 (69.7%) after one month, 131 (60.0%) after three months, and 123 (56.4%) patients after six months. The therapeutic effect of one TFESI along with caudal ESI was better than two TFESIs in for one, threes, and six months (p < 0.01). Conclusion: Transforaminal epidural steroid with caudal epidural injection is a more effective tool for lumbosacral radiculopathy than two level transforaminal injections in multi-level radiculopathy patients. symptoms attributed to lumbosacral radiculopathy. In multi-level radiculopathy patients, therapeutic effect of one level epidural steroid injection has been limited. Thus, we focused on additional epidural injections for treating multi-level herniated disc patients. The objectives of our study were comparing the therapeutic effect and complication rates between two level injections and a one level injection along with caudal injection. Index terms MATERIALS AND METHODS PatientsLumbar ESIs were performed from January 2012 to January 2015. Among the patients, 895 consecutive lumbar ESIs in 492 were reviewed. We received approval from Institutional Review Board. Total 895 lumbar ESIs (285 men, 207 women; mean age, 63.9 years) were used for analysis. There is no significant difference in the two groups' age range. The initial Numeric Rating Scale (NRS) score was assessed in every patient (Table 1), dividing them into no, mild (NRS: 1-3), moderate (NRS: 4-6), and severe pain (NRS: 7-10) categories. We classified the patients into two groups based on the NRS anddefined marked improvement with no pain as a satisfactory result for therapeutic effect.Retrospectively, the therapeutic effect difference in the groups was evaluated: one level transforaminal epidural steroid injection (TFESI) along with caudal epidural injection and two level TFESIs for lumbosacral radiculopathy. The inclusion criteria were presence of low...

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Section: Introductionmentioning

confidence: 99%

Comparison of the Therapeutic Effect between a Transforaminal along with a Caudal Epidural Injection, as Well as Two-Level Transforaminal Epidural Injections in a Radiculopathy Patient

Hwang

Cho

et al. 2017

J Korean Soc Radiol

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“…The prevalence of sciatica is about 5.3% in men and 3.7% in women, representing a nearly 6 % of total disability cases (Heliovaara et al, 1987). Epidural steroid injection has been commonly used as a non-surgical treatment for radicular pain (Bogduk et al, 1994;Goebert et al, 1961). While a number of open-label clinical studies have shown the beneficial effects of epidural steroid injection (e.g., Spaccarelli et al, 1996), several prospective, randomized, controlled studies have failed to provide convincing evidence for its clinical efficacy (Armon et al, 2007;Carette et al, 1997;Arden et al, 2005;Price et al, 2005;Valat et al, 2003).…”

Section: Introductionmentioning

confidence: 99%

Time-dependent effect of epidural steroid on pain behavior induced by chronic compression of dorsal root ganglion in rats

Wang

Yang

et al. 2007

Brain Research

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Although epidural steroid injection has been commonly used to treat radicular pain, its clinical efficacy remains controversial. In a rat model of radicular pain induced by chronic compression of lumbar dorsal root ganglion (CCD), we examined the effect of epidural steroid on CCD-induced pain behavior. Triamcinolone [a glucocorticoid receptor (GR) agonist] or RU38486 (a GR antagonist) was given epidurally once either on day 3 (early treatment) or day 10 (late treatment) after CCD. The results showed that 1) early treatment with triamcinolone and RU38486 alone, respectively, reduced and exacerbated mechanical allodynia and thermal hyperalgesia, 2) late treatment with triamcinolone alone failed to improve mechanical allodynia and only transiently attenuated thermal hyperalgesia, and 3) late treatment with RU38486 alone improved mechanical allodynia and thermal hyperalgesia in CCD rats. Moreover, a second dose of triamcinolone given on day 10 paradoxically exacerbated pain behavior in CCD rats that received a first dose of triamcinolone on day 3. These results indicate that the effect of epidural steroid on radicular pain may be time-dependent. Clinical implications for epidural steroid treatment are discussed in light of these preclinical findings.

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“…Outros autores referem incidência de 5% a 6% e com efeitos que podem ser perigosos [13][14][15][16][17][18] . Os riscos são vários e incluem bloqueio subaracnóideo 19 , sintomas neurológicos leves 20,21 , como parestesias e diminuição da força muscular, pleiocitoses de até 3.000/mm 3 , com alta concentração de proteínas, e convulsões generalizadas devido ao efeito químico irritativo 22 . Ainda podem se observados incontinência urinária 23 , aracnoidite constritiva, meningite asséptica, hemorragia subaracnóidea, bexiga neurogênica 24,25 e lesão nervosa (lesões encefálicas e da medula espinhal) 17,26 .…”

Section: Discussionunclassified

“…Others studies have found adverse effects in 5% to 6% [13][14][15][16][17][18] . Risks include spinal block 19 , mild neurological symptoms 20,21 such as paresthesias and decreased muscle strength, pleocytosis of up to 3000/mm 3 with high protein concentration, and generalized seizures due to irritating chemical effect 22 . Urinary incontinence 23 , constrictive arachnoiditis, aseptic meningitis, subarachnoid hemorrhage, neurogenic bladder 24,25 and nervous injuries (brain and spinal cord injuries) 17,26 may also be observed.…”

Section: Discussionmentioning

confidence: 99%

Injeção subaracnóidea inadvertida de corticóide em tratamento de dor crônica da coluna lombar: relato de caso

Vanni¹

2004

Rev. Bras. Anestesiol.

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PAINFUL RADICULOPATHY treated with EPIDURAL INJECTIONS OF PROCAINE AND HYDROCORTISONE ACETATE

Cited by 96 publications

References 0 publications

Comparison of the Therapeutic Effect between a Transforaminal along with a Caudal Epidural Injection, as Well as Two-Level Transforaminal Epidural Injections in a Radiculopathy Patient

Comparison of the Therapeutic Effect between a Transforaminal along with a Caudal Epidural Injection, as Well as Two-Level Transforaminal Epidural Injections in a Radiculopathy Patient

Time-dependent effect of epidural steroid on pain behavior induced by chronic compression of dorsal root ganglion in rats

Injeção subaracnóidea inadvertida de corticóide em tratamento de dor crônica da coluna lombar: relato de caso

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