scholarly journals The Incidence of Lumbar Discectomy after Epidural Steroid Injections or Selective Nerve Root Blocks

10.14444/2012 ◽  
2015 ◽  
Vol 9 ◽  
pp. 12 ◽  
Author(s):  
William F. Lavelle ◽  
Thomas Mroz ◽  
Isador Lieberman
Keyword(s):  
Nerve Root ◽  
Lumbar Discectomy ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Nerve Root Blocks ◽  
Epidural Steroid

scholarly journals Caudal epidural steroid injections versus selective nerve root blocks for single-level lumbar spinal stenosis: a study protocol for a randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Akram Osman ◽  
Wei Hu ◽  
Jianhua-Sun ◽  
Jing Li ◽  
Xiao Luo ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Nerve Root ◽  
Controlled Trial ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Randomized Controlled ◽  
Nerve Root Blocks ◽  
Lumbar Spinal ◽  
Epidural Steroid ◽  
Caudal Epidural

Abstract Background Lumbar spinal stenosis (LSS) is a common degenerative condition associated with old age. Its incidence continues to increase with the rapidly aging population in China. Treatment for LSS usually begins with conservative treatments, as some patients refuse surgical procedures or have surgery contraindications. Caudal epidural steroid injections (CESIs) and selective nerve root blocks (SNRBs) are two commonly used conservative treatments for LSS, which have proven to be effective at relieving LSS symptoms in many studies. However, there are no randomized controlled trials comparing these two procedures. We planned the first study to assess which one of these two procedures is more effective in treating LSS. We will compare the efficacy of these two treatment methods in terms of duration of symptom relief and recurrence rate. We hope our findings will help clinicians choose an optimal treatment for LSS patients. Methods/design We plan to conduct a 1-year randomized controlled trial that will include a total of 76 subjects. They will be randomly divided into two groups: group A (patients will receive CESIs) and group B (patients will receive SNRBs). Two days before the procedure, we will assess these patients using the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale, Oswestry Disability Index (ODI), and numeric rating scale (NRS) for pain. One day, 2 weeks, 3 months, 6 months, and 1 year after the procedure, we will assess the condition of these patients again with the NRS and ODI. Discussion We hope our findings will lay the foundation for the design of further comprehensive studies and help clinicians make a choice between CESIs and SNRBs for LSS patients. Trial registration Chinese Clinical Trial Registry ChiCTR1900028038. Registered on 8 December 2019

scholarly journals Contrast Flow Selectivity During Transforaminal Lumbosacral Epidural Steroid Injections

2008 ◽  
Vol 6;11 (12;6) ◽  
pp. 855-861
Author(s):  
Michael B. Furman
Keyword(s):  
Epidural Space ◽  
Nerve Root ◽  
Lumbar Disc ◽  
Human Study ◽  
Contralateral Side ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Needle Position ◽  
Epidural Steroid ◽  
Contrast Flow

Background: Lumbosacral transforaminal epidural steroid injections (LS-TFESIs) are an accepted procedure used in the comprehensive, conservative care for lumbar disc pathology and/or spinal stenosis induced low back pain with a radicular component. Historically, the terminology used to describe the transforaminal technique of instilling medications into the epidural space and/or exiting structures has varied. These procedures have also been referred to as either diagnostic or therapeutic selective nerve root blocks (SNRBs). Although this procedure is typically used to “selectively” treat isolated pathology, the “SNRB” terminology suggests that one can selectively diagnose or treat a specific nerve root as a pain generator by anesthetizing or blocking it. It has been recently demonstrated that L4 and L5 SNRBs are often non-“selective” by investigating the extent of epidural contrast flow patterns after injecting 1.0 mL of contrast. Our study attempts to identify the minimum injectate volume at which LS-TFESIs may still be considered “selective” with no injectate extending to either the adjacent (superior and/or inferior) levels or to the contralateral side. Objective: Quantitatively evaluate contrast flow level selectivity noted during fluoroscopically guided lumbosacral transforaminal epidural steroid injections (LS-TFESIs). Study Design: Prospective, nonrandomized, observational human study. Methods: Thirty patients (female = 10, male = 20) undergoing LS-TFESIs were investigated. After confirming appropriate spinal needle position with biplanar imaging, 4.0 mL of nonionic contrast was slowly injected. Fluoroscopic images were recorded at 0.5 mL increments. These biplanar contrast flow images were evaluated to determine which 0.5 mL volume increment was no longer specific for the injected level. In particular, we documented when contrast extended either to a superior or inferior spinal segment or crossed the midline spine to the contralateral side. Results: After injecting 0.5 mL of contrast, 30% of LS-TFESIs performed in this study were no longer “selective” for the specified root level. After injecting 1.0 mL of contrast, 67% of LS-TFESIs performed in this study were no longer “selective” for the specified root level. After injecting 1.5 mL of contrast, 87% of LS-TFESIs performed in this study were no longer “selective” for the specified root level. After injecting 2.5 mL of contrast, 90% of LS-TFESIs performed in this study were no longer “selective” for the specified root level. Conclusions: Diagnostic LS-TFESI or SNRB blocks limiting injectate to a single, ipsilateral segmental level cannot reliably be considered diagnostically selective with volumes exceeding 0.5mL. Injectate volumes greater than 0.5mL are consistently non-selective and cannot be used reliably for diagnostic block procedures in the epidural space. Key words: Epidural steroid injections, selective nerve root block, transforaminal, contrast flow

scholarly journals Complex Regional Pain Syndrome Type II After Cervical Interlaminar Epidural Injection

2021 ◽  
pp. 213-217
Keyword(s):  
Case Report ◽  
Complex Regional Pain Syndrome ◽  
Nerve Root ◽  
Stellate Ganglion ◽  
Stellate Ganglion Block ◽  
Pain Syndrome ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Nerve Root Injury ◽  
Epidural Steroid

BACKGROUND: Complex regional pain syndrome (CRPS) is a pain condition associated with autonomic and inflammatory features and is characterized by pain that is disproportionate in magnitude to the typical pain after similar injuries. The pathophysiology of CRPS is poorly understood, and many events have been implicated as causative factors. CASE REPORT: There are 2 previously documented case reports of CRPS after epidural steroid injections (ESI). This case report details the development of CRPS symptoms in a patient after receiving a cervical ESI. The precipitating event could have been trauma to a nerve root, nerve root irritation from the injectate, or contrast media reaction. Treatment focused on physical therapy and early intervention with a stellate ganglion block. The patient had complete resolution of her symptoms after 10 months. CONCLUSIONS: Although rare, CRPS due to direct nerve root injury or nerve root irritation can develop after an ESI; early diagnosis and treatment may result in a better outcome. KEY WORDS: Complex regional pain syndrome, CRPS, epidural steroid injections, TFESI, ILESI

scholarly journals Comparative study between transforaminal epidural selective nerve root block versus interlaminar epidural in the treatment of lumbar radicular leg pain

2019 ◽  
Vol 5 (4) ◽  
pp. 694
Author(s):  
Mohammed Sadiq ◽  
Syed Azher Hussain ◽  
Mohammed Nayeemuddin
Keyword(s):  
Targeted Delivery ◽  
Nerve Root ◽  
Comparative Trial ◽  
Epidural Injection ◽  
Leg Pain ◽  
Disc Disease ◽  
Nerve Roots ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Epidural Steroid

<p class="abstract"><strong>Background:</strong> Sciatic neuralgia is a result of nerve root oedema because of the inflammatory, immunological and mechanical factors. Steroid injections play an important role in the management of sciatic radiculopathy. Steroids act by reducing the oedema around the nerve roots and decreasing pain. Locally administered steroids have the advantage of reduced dosage and targeted delivery around the nerve roots. This forms the basis of epidural steroid injections. This can be given around the nerve root in the transforaminal space or in the interlaminar space. There is a paucity of literature comparing the two techniques of epidural steroid injections. We have done a randomized comparative trial, to compare the effectiveness of the two modalities of injection in the management of a single level unilateral foraminal disc herniation.</p><p class="abstract"><strong>Methods:</strong> Patients were randomized in two groups Group A: Transforaminal epidural (SNRB) and Group B: interlaminar epidural. Same dose of steroid was used in each group.<strong></strong></p><p class="abstract"><strong>Results:</strong> Immediate post injection, 2 week and 1 month transforaminal epidural (SNRB) was better compare to interlaminar epidural however at the end of 3 months the difference was not significant (p=0.08).</p><p><strong>Conclusions:</strong> Both transforaminal and interlaminar epidural injection are effective form of treatment in mild to moderate grade of disc disease. Both the technique provide short lasting relief in the symptoms associated with disc pathology, however pain management is better in transforaminal group compared to interlaminar group. Thus these techniques can be considered for delaying surgery and providing intermitant relief. </p>

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