Transforaminal epidural steroid injection via a preganglionic approach for the treatment of lumbar radicular pain

Cansever, Tufan; Kabataş, Serdar; Çivelek, Erdinç; Kircelli, Atilla; Yilmaz, Cem; Müslüman, Murat; Ofluoğlu, Demet; Caner, Hakan

doi:10.5137/1019-5149.jtn.5151-11.3

Cited by 10 publications

(18 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Two included long-term follow-up for 1 year or more. 16,28 However, the studies with long-term followup had mixed results, in that one was positive and the other negative at long-term follow-up. The remainder analyzed periods up to 6 months, and all demonstrated that a single epidural injection was effective in alleviating LBP from spinal stenosis and lumbar radiculopathy.…”

Section: Single Injectionmentioning

confidence: 96%

“…10,11 Nine studies demonstrated that ESI was beneficial in the short term for treating radicular pain of any cause, and the single study that included a control group demonstrated that NSEI was equally effective. 28,[30][31][32][33][34][35][36][37] Four studies reported on radicular pain because of any cause other than spinal stenosis, and found that ESI was effective at reducing radicular symptoms in the short term. 29,[38][39][40] Two of these studies differentiated between low back and radicular pain, and ESI was equally effective at reducing both pain types.…”

Section: Radicular Pain From All Causesmentioning

confidence: 99%

“…Of the studies reviewed, 34 considered duration of effect (the other 5 studies were meta-analyses that did not comment on duration of effective relief). Of these 34 studies, 11 used a single injection, 6,[9][10][11][12]16,27,28,31,33,35 whereas the remainder allowed for or performed multiple injections during the follow-up period.…”

Section: Duration Of Effectmentioning

confidence: 99%

“…However, long-term results were mixed: 1 negative and 2 positive, with none demonstrating efficacy compared with control groups. [28][29][30] Two studies considered spinal stenosis and radicular pain, differentiating between the 2, and found that both ESI and NSEI were effective at reducing radicular pain in the short term. 10,11 Nine studies demonstrated that ESI was beneficial in the short term for treating radicular pain of any cause, and the single study that included a control group demonstrated that NSEI was equally effective.…”

Section: Radicular Pain From All Causesmentioning

confidence: 99%

See 3 more Smart Citations

When Do Lumbar Epidural Steroid Injections Help? A Systematic Review

Kiritsy¹,

Siefferman²

2016

Topics in Pain Management

View full text Add to dashboard Cite

L ow back pain (LBP) is a common symptom, and patients often present to interventional pain specialists for an epidural steroid injection (ESI). However, much of the data surrounding the efficacy of ESI for LBP is conflicting. Part 1 of this 2-part series is a general review of the literature with best available recommendations. In part 2, some of the more relevant articles analyzed are reviewed as an appendix.The goal of this systematic review article is to determine under which conditions an ESI may be helpful for LBP. All meta-analyses and clinical trials known by the authors to have been published within the last 5 years were reviewed.In the review, there was a vast degree of heterogeneity in causes of LBP, injection approach, volume, and composition. The data demonstrated consistent level I evidence supporting the use of ESI for short-term relief of radicular pain from herniated discs, with a transforaminal approach being the most common technique. For spinal stenosis, epidural injections with or without steroids were equally effective and superior to placebo or to no epidural injection.The results suggest that the cause of LBP is likely an important factor for determining whether an epidural injection will Learning Objectives: After participating in this CME activity, the physician should be better able to: 1. Explain the current literature regarding the efficacy of lumbar epidural injections for low back pain. 2. Understand the effect that approach may have on the efficacy of epidural injections. 3. Describe variables in injected medications and how they affect the efficacy of lumbar epidural injections. 4. Increase awareness about the challenges that exist in studying epidural injection efficacy for low back pain.

show abstract

Section: Single Injectionmentioning

confidence: 96%

Section: Radicular Pain From All Causesmentioning

confidence: 99%

Section: Duration Of Effectmentioning

confidence: 99%

Section: Radicular Pain From All Causesmentioning

confidence: 99%

See 2 more Smart Citations

When Do Lumbar Epidural Steroid Injections Help? A Systematic Review

Kiritsy¹,

Siefferman²

2016

Topics in Pain Management

View full text Add to dashboard Cite

show abstract

“…A dose-dependent impairment in immune function stems from transcriptional changes that suppress inflammatory genes (via transrepression), upregulate anti-inflammatory genes (via transactivation) and inhibit B and T cells and phagocytes [57]. Although retrospective studies on infection following ESI are lacking, case reports indicate infection may follow ESI in patients with preexisting immunosuppressive conditions, which include diabetes, cancer (with or without metastasis), neutropenia, oral steroid use, prior history of infections [58] and renal failure [59]. Other conditions that also limit immune function include HIV infection, alcoholic cirrhosis and asplenia [60].…”

Section: • Immune Systemmentioning

confidence: 99%

Epidural Steroid Injections: An Updated Review on Recent Trends in Safety and Complications

Bicket

Chakravarthy²,

Chang³

et al. 2015

Pain Manag.

View full text Add to dashboard Cite

Epidural steroid injections (ESIs), which can provide significant but temporary pain relief in well-selected patients, are the most commonly performed procedure in pain management. The anatomy of the epidural space provides a framework for understanding risks associated with ESIs, a topic relevant to both patients and physicians in interventional pain, surgery and primary care. Safety considerations of epidural steroids include drug preparation and myriad physiological effects stemming from steroid exposure. Although major complications associated with ESI occur rarely, potentially catastrophic events resulting from infectious, hematologic and neurologic morbidity may lead to permanent injury. The safety profile of ESIs may improve with development and dissemination of sound injection technique, safer compounds manufactured in a sterile manner and deficient of thromboembolic potential and the application of existing technology.

show abstract

Safety of Epidural Corticosteroid Injections

et al. 2015

View full text Add to dashboard Cite

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.

show abstract

Transforaminal epidural steroid injection via a preganglionic approach for the treatment of lumbar radicular pain

Cited by 10 publications

References 21 publications

When Do Lumbar Epidural Steroid Injections Help? A Systematic Review

When Do Lumbar Epidural Steroid Injections Help? A Systematic Review

Epidural Steroid Injections: An Updated Review on Recent Trends in Safety and Complications

Safety of Epidural Corticosteroid Injections

Contact Info

Product

Resources

About