scholarly journals Corrigendum to: A Randomized Comparative Trial of Targeted Steroid Injection via Epidural Catheter vs Standard Transforaminal Epidural Injection for the Treatment of Unilateral Cervical Radicular Pain: Six-Month Results

Pain Medicine ◽  
2021 ◽  
Author(s):  
Zachary L McCormick ◽  
Aaron Conger ◽  
Beau P Sperry ◽  
Masaru Teramoto ◽  
Russell Petersen ◽  
...  
Keyword(s):  
Epidural Catheter ◽  
Steroid Injection ◽  
Comparative Trial ◽  
Epidural Injection ◽  
Radicular Pain ◽  
Transforaminal Epidural Injection

One-year results from a randomized comparative trial of targeted steroid injection via epidural catheter versus standard transforaminal epidural injection for the treatment of unilateral cervical radicular pain

2021 ◽  
pp. rapm-2021-102514
Author(s):  
Aaron Conger ◽  
Richard W Kendall ◽  
Beau P Sperry ◽  
Russell Petersen ◽  
Fabio Salazar ◽  
...  
Keyword(s):  
Rating Scale ◽  
Steroid Injection ◽  
Neck Disability Index ◽  
Comparative Trial ◽  
Epidural Injection ◽  
Pain Reduction ◽  
Radicular Pain ◽  
Patient Global Impression ◽  
Neck Disability ◽  
Global Impression Of Change

ObjectivesThe objective of this study was to evaluate the long-term effectiveness of catheter-directed cervical interlaminar epidural steroid injection with triamcinolone compared with cervical transforaminal steroid injection with dexamethasone for the treatment of refractory unilateral radicular pain.DesignProspective, randomized, comparative trial.MethodsThe primary outcome was the proportion of participants with ≥50% Numeric Rating Scale ‘dominant pain’ (the greater of arm vs neck) reduction from baseline. Secondary outcomes included ≥30% Neck Disability Index reduction and Patient Global Impression of Change response indicating ‘much improved’ or ‘very much improved’.ResultsData from 117 participants (55.6% women; 52.3±12.5 years of age; body mass index, 28.2±6.5 kg/m2) were analyzed. The proportion of participants who experienced ≥50% pain reduction at 1 month, 3 months, and 6 months has been previously reported. At 1 year, 61.2% (95% CI, 46.9% to 73.9%) of the catheter group compared with 51.9% (95% CI, 38.4% to 65.2%) of the transforaminal group reported ≥50% ‘dominant’ pain reduction (p=0.35). The proportion of participants who experienced ≥30% improvement in Neck Disability Index score was 60.4% (95% CI, 45.9% to 73.3%) and 47.1% (95% CI, 33.7% to 60.8%) in the catheter and transforaminal groups (p=0.18). Patient Global Impression of Change improvement was similar in both groups: 60.5% (95% CI, 44.2% to 74.8%) and 57.5% (95% CI, 41.7% to 71.9%) of the catheter and transforaminal groups reported being ‘much improved’ or ‘very much improved’, respectively (p=0.79).ConclusionBoth cervical catheter-directed interlaminar epidural injection and cervical transforaminal steroid injection were effective in reducing pain and disability in the majority of participants with refractory unilateral cervical radiculopathy for up to 1 year.

scholarly journals A Randomized Comparative Trial of Targeted Steroid Injection via Epidural Catheter vs Standard Transforaminal Epidural Injection for the Treatment of Unilateral Cervical Radicular Pain: Six-Month Results

Pain Medicine ◽  
2020 ◽  
Vol 21 (10) ◽  
pp. 2077-2089 ◽  
Author(s):  
Zachary L McCormick ◽  
Aaron Conger ◽  
Beau P Sperry ◽  
Masaru Teramoto ◽  
Russell Petersen ◽  
...  
Keyword(s):  
Rating Scale ◽  
Steroid Injection ◽  
Neck Disability Index ◽  
Comparative Trial ◽  
Epidural Injection ◽  
Cervical Radiculopathy ◽  
Numeric Rating Scale ◽  
Radicular Pain ◽  
Interlaminar Epidural Steroid Injection ◽  
Neck Disability

Abstract Objectives Compare the effectiveness of catheter-directed cervical interlaminar epidural steroid injection (C-CIESI) with triamcinolone to cervical transforaminal steroid injection (CTFESI) with dexamethasone for the treatment of refractory unilateral radicular pain. Design Prospective, randomized, comparative trial. Methods Primary outcome: proportion of participants with ≥50% numeric rating scale pain score reduction from baseline “dominant pain” (the greater of arm vs neck) at one month postinjection. Secondary outcomes: ≥30% Neck Disability Index (NDI-5) reduction and Patient Global Impression of Change (PGIC) response indicating “much improved” or “very much improved.” Results One hundred twenty participants (55.6% females, 52.3 ± 12.5 years of age, BMI 28.2 ± 6.5 kg/m2), were enrolled. The proportions of participants who experienced ≥50% pain reduction at one, three, and six months were 68.5% (95% CI = 54.9–79.5%), 59.3% (95% CI = 45.7–71.6%), and 60.8% (95% CI = 46.7–73.2%), respectively, in the C-CIESI group compared with 49.1% (95% CI = 36.4–62.0%), 46.4% (95% CI = 33.8–59.6%), and 51.9% (95% CI = 38.4–65.2%), respectively, in the CTFESI group. The between-group difference at one month was significant (P = 0.038). The proportions of participants who experienced a ≥30% NDI-5 score improvement were 64.0% (95% CI = 49.8–76.1%) and 54.9% (95% CI = 41.1–68.0%) in the C-CIESI and CTFESI groups (P = 0.352). Participants reported similar PGIC improvement in both groups: At six months, 53.2% (95% CI 38.9–67.1%) and 54.5% (95% CI = 39.7–68.7%) of the C-CIESI and CTFESI groups reported being “much improved” or “very much improved,” respectively (P = 0.897). Conclusions Both C-CIESI with triamcinolone and CTFESI with dexamethasone are effective in reducing pain and disability associated with refractory unilateral cervical radiculopathy in a substantial proportion of participants for at least six months.

scholarly journals Correlation of Perfusion Index Change and Analgesic Efficacy in Transforaminal Block for Lumbosacral Radicular Pain

2019 ◽  
Vol 8 (1) ◽  
pp. 51 ◽  
Author(s):  
Jin Young Lee ◽  
Eung Don Kim ◽  
Yoo Na Kim ◽  
Ji Seob Kim ◽  
Woo Seog Sim ◽  
...  
Keyword(s):  
Area Under The Curve ◽  
Analgesic Efficacy ◽  
Epidural Injection ◽  
Pain Reduction ◽  
Radicular Pain ◽  
Perfusion Index ◽  
Objective Method ◽  
Peripheral Perfusion ◽  
Index Change ◽  
Transforaminal Epidural Injection

Transforaminal epidural injection is used to treat radicular pain. However, there is no objective method of assessing pain relief following transforaminal injection. Perfusion index is a metric for monitoring peripheral perfusion status. This study evaluates the correlation between perfusion index change and analgesic efficacy in transforaminal blocks for lumbosacral radicular pain. We retrospectively analyzed data of 100 patients receiving transforaminal block for lumbosacral radicular pain. We assessed perfusion index before treatment and at 5, 15, and 30 min following the block. We defined responders (group R) and non-responders (group N) as those with ≥50% and <50% pain reduction, respectively, 30 min following block. Clinical data and perfusion index of the groups were analyzed. Ninety-two patients were examined, of whom 57 (61.9%) and 35 (38.0%) patients reported ≥50% and <50% pain reduction, respectively. Group R had a significantly higher perfusion index change ratio 5 min following the block (p = 0.029). A perfusion index change ratio of ≥0.27 was observed in group R (sensitivity, 75.4%; specificity, 51.4%; AUC (area under the curve), 0.636; p = 0.032). A perfusion index change ratio of ≥0.27 at 5 min after block is associated with, but does not predict improvement in, pain levels following lumbosacral transforaminal block.

scholarly journals Transforaminal Epidural Injection of Dexamethasone vs Methylprednisolone in Reducing Low Back Pain and Disability in Prolapsed Lumbar Intervertebral Disc in Manipur, India: A RCT

2021 ◽  
Author(s):  
Kanti Rajkumari ◽  
Akoijam Joy Singh ◽  
Longjam Nilachandra Singh ◽  
Margaret Chabungbam ◽  
C Sreejith ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Intervertebral Disc ◽  
Steroid Injection ◽  
Epidural Injection ◽  
P Value ◽  
Low Back ◽  
Lumbar Intervertebral Disc ◽  
Transforaminal Epidural Injection ◽  
Epidural Steroid

Introduction: Treatment for Low Back Pain (LBP) due to Prolapsed Intervertebral Disc (PIVD) includes conservative management, Epidural Steroid Injection (ESI), and surgery. Transforaminal Epidural Steroid Injection (TFESI) is a more recently described approach. All corticosteroid preparations used for TFESI are particulate except dexamethasone and betamethasone sodium phosphate. But while comparing methylprednisolone with dexamethasone, the latter has more potent anti-inflammatory action with least likelihood of causing embolic events and is also less expensive. Aim: To compare the efficacy of transforaminal epidural injection of dexamethasone and methylprednisolone in reducing LBP and disability in prolapsed lumbar intervertebral disc amongst the indigenous population of Manipur, India. Materials and Methods: This was a randomised controlled study on 80 patients with PIVD attending Outpatient Department (OPD) at physical medicine and rehabilitation was conducted from September 2016 to August 2018. A single dose of lumbar TFESI with dexamethasone in the study group and methylprednisolone in the control were given under C-arm guidance. The outcome variables Visual Analog Scale (VAS) for pain and Oswestry Disability Index (ODI) for function were measured at one week, one month and six months. Statistical tests like t-test, Chi-square test were used for intra group and inter group analysis. Results: In the total sample of 80 patients, 40 (15 males and 25 females, mean age: 38.28±8.55 years) were categorised as Dexamethasone patients and 40 (17 males and 23 females; mean age: 39.28±7.80 years) as methylprednisolone patients, there were significant improvement in mean score of VAS and ODI in both the groups (p-value <0.05). At six months, both treatment groups maintained initial observed improvements, with no significant differences between groups on the VAS {95% Confidence Interval (CI), -0.02 to 0.4; p-value=0.07} and ODI (95% CI,-0.21 to 3.43; p-value=0.08). Conclusion: Non-particulate steroid dexamethasone was similar in efficacy to the particulate steroid methylprednisolone in lumbar TFESI. However, in view of the greater safety profile of dexamethasone, it is suggested that dexamethasone may be used as the preferred agent in lumbar TFESI.

Pre-Contrast Injection Multiple Needle Placement Technique: An Alternative Method for Performing Challenging Transforaminal Epidural Steroid Injections for Radicular Pain

2020 ◽  
pp. 39-44
Author(s):  
Sanjeeva Gupta
Keyword(s):  
Steroid Injection ◽  
Epidural Injection ◽  
Radicular Pain ◽  
Epidural Steroid Injection ◽  
Needle Placement ◽  
Contrast Injection ◽  
Epidural Steroid Injections ◽  
Key Words Epidural ◽  
Epidural Steroid ◽  
Placement Technique

Abstract: A subpedicular transforaminal epidural steroid injection (TFESI) at the L5-S1 level can be technically challenging due to lumbar spondylosis. As described in the cases below, in challenging cases, placing multiple needles (normally 2 needles, occasionally 3 needles) before injecting the radiocontrast dye can improve the chances of depositing the steroid in the area of pathology responsible for pain. This will, of course, add to the risk of the procedure due to multiple needles being close to the nerve root. On balance, however, it may be less risky than not placing the steroid at the appropriate pathological site, which may fail to provide pain relief leading to unnecessary suffering and, in some cases, surgical intervention. However, if the spread of contrast medium and the subsequent steroid injection through the first needle is satisfactory, then the other needles can be removed without injecting. The “pre-contrast injection multiple needle placement” technique has been used by the author on multiple occasions and 3 cases are described below. Key words: Epidural steroid injection, transforaminal epidural injection, sciatica, radicular pain, multiple needle technique

scholarly journals Chemical meningitis after cervical transforaminal epidural steroid injection: a case report

2021 ◽  
Vol 49 (2) ◽  
pp. 030006052199397
Author(s):  
Min Young Lee ◽  
Min Cheol Chang
Keyword(s):  
Steroid Injection ◽  
Epidural Injection ◽  
Complete Relief ◽  
Neck Stiffness ◽  
Csf Analysis ◽  
Transforaminal Epidural Injection ◽  
Transforaminal Epidural Steroid Injection ◽  
The Right ◽  
Epidural Steroid ◽  
Chemical Meningitis

We herein report a case of chemical meningitis that developed after cervical transforaminal steroid injection. A 49-year-old man presented with symptoms of meningitis (severe headache and neck stiffness) after cervical transforaminal steroid injection at the right C5–6 level. The injection solution was a mixture of lidocaine (0.3 mL), hyaluronidase (1 mL), placenta hydrolysate (2 mL), and normal saline (1 mL). The patient developed symptoms of meningitis 2.5 hours after the cervical epidural injection. Cerebrospinal fluid (CSF) analysis was performed 1 day after the injection, and the results showed an elevated white blood cell count at 7106 cells/µL. The patient’s CSF analysis findings and symptoms did not differ from those of bacterial meningitis. However, considering that his symptoms developed 2.5 hours after the epidural injection, we believe that the patient developed chemical meningitis; therefore, he was symptomatically treated with an analgesic. Three days after the cervical transforaminal epidural injection, the patient experienced complete relief from the headache and neck stiffness. A Gram stain of the CSF revealed no organisms. Hence, the diagnosis of chemical meningitis was confirmed. Clinicians should be knowledgeable about the risk of this complication.

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