scholarly journals Optimal Contrast Concentration for CT-Guided Epidural Steroid Injections

2013 ◽  
Vol 35 (1) ◽  
pp. 191-195 ◽  
Author(s):  
P.G. Kranz ◽  
M. Abbott ◽  
D. Abbott ◽  
J.K. Hoang
Keyword(s):  
Ct Guided ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Epidural Steroid

scholarly journals The Safety of CT-Guided Epidural Steroid Injections in an Older Patient Cohort

2016 ◽  
Vol 8;19 (8;11) ◽  
pp. E1139-E1146
Author(s):  
Andrew J. Fenster
Keyword(s):  
Back Pain ◽  
Procedure Time ◽  
Older Patient ◽  
Dose Length Product ◽  
Ct Guided ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
The Mean ◽  
Procedure Duration ◽  
Epidural Steroid

Background: Epidural steroid injections (ESIs) are a common method for treating lower back pain, which is one of the most prevalent health-related complaints in the adult U.S. population. Although the safety of CT-guided ESIs has been extensively studied in adults, there is limited data concerning the procedure’s safety profile in an older patient population. Objective: This retrospective study analyzed safety data among a single-center cohort of patients > 65 years-old who received one or more CT-guided interlaminar ESIs from 2012 to 2015. Study Design: An Institutional Review Board (IRB)-approved retrospective chart review. Setting: University hospital center. Methods: A total of 688 CT-guided ESI procedures were evaluated and a linear regression analysis was conducted to examine the relationship between dose length product (DLP), body mass index (BMI), procedure duration, and kVp/mA settings. Further analysis was performed on a sample of long procedure time, average-DLP and high-DLP procedures. Results: Average age was 75.77 years, with 44% having a BMI > 30. The mean DLP was 55.58 mGy x cm and the mean procedure duration was 5.94 minutes. All procedures were technically successful and no complications were observed during or after any of the procedures, including at one-month follow-up office visits. The kVp and mA settings were the strongest predictors of DLP, followed by procedure time. The high-DLP cases had a greater number of needle placement series, more intervertebral disc spaces included in each planning series and higher machine settings (kVp 120; mA 87.5) than the average-DLP cases (kVp 100; mA 49.9). Limitations: This study is limited by its retrospective design. Conclusion: CT-guided interlaminar ESIs can be performed safely, with low procedure times, relatively low DLP’s and without complications in an older patient population. Key words: Epidural steroid injection, interlaminar approach, CT-guidance, older adults, back pain, lumbar spine, thoracic spine, cervical spine, dose length product, radiation exposure

scholarly journals Radiation Dose for 345 CT-Guided Interlaminar Lumbar Epidural Steroid Injections

2013 ◽  
Vol 34 (10) ◽  
pp. 1882-1886 ◽  
Author(s):  
A.L. Chang ◽  
A.H. Schoenfeld ◽  
A.L. Brook ◽  
T.S. Miller
Keyword(s):  
Radiation Dose ◽  
Ct Guided ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Epidural Steroid

CT-guided cervical transforaminal epidural steroid injections: Technical insights

2014 ◽  
Vol 41 (3) ◽  
pp. 211-215 ◽  
Author(s):  
John T. Wald ◽  
Timothy P. Maus ◽  
Felix E. Diehn ◽  
Timothy J. Kaufmann ◽  
Jonathan M. Morris ◽  
...  
Keyword(s):  
Ct Guided ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Epidural Steroid

The retroneural approach: an alternative technique for lumbar transforaminal epidural steroid injections

2018 ◽  
Vol 59 (12) ◽  
pp. 1508-1516
Author(s):  
Stefan Ignjatovic ◽  
Reza Omidi ◽  
Rahel A Kubik-Huch ◽  
Suzanne Anderson ◽  
Frank J Ahlhelm
Keyword(s):  
Pain Relief ◽  
Nerve Root ◽  
Spinal Cord Infarction ◽  
Short Term ◽  
Neural Foramen ◽  
Ct Guided ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Tip Position ◽  
Epidural Steroid

Background Compared with other available injection techniques for lumbar transforaminal epidural steroid injections (LTFESIs), the traditionally performed subpedicular approach is associated with a higher risk of spinal cord infarction, a rare but catastrophic complication. Purpose To assess the short-term efficacy of the retroneural approach for computed tomography (CT)-guided LTFESIs with respect to different needle-tip positions. Material and Methods This retrospective analysis included 238 patients receiving 286 CT-guided LTFESIs from January 2013 to January 2016. Short-term outcomes in terms of pain relief were assessed using the visual analogue scale (VAS) at baseline and 30 min after. The needle-tip location was categorized as extraforaminal, junctional, or foraminal relative to the neural foramen. Additionally, the distance from the needle tip to the nerve root was measured. Results A mean pain reduction of 3.22 points (±2.17 points) on the VAS was achieved. The needle-tip location was extraforaminal in 48% (136/286), junctional in 42% (120/286), and foraminal in 10% (28/286) of the cases. The mean distance from the needle tip to the nerve root was 3.83 mm (±3.37 mm). There was no significant correlation between pain relief and needle-tip position in relation to the neural foramen. Therapy success was not dependent on the distance between the needle tip and the nerve root. No major complications were observed. Conclusion In our population treated with LTFESIs, the retroneural approach was shown to be an effective technique, with no significant differences in pain relief following different needle-tip positions.

Comparison of treatment outcomes in lumbar disc herniation patients treated with epidural steroid injections: interlaminar versus transforaminal approach

2019 ◽  
Vol 61 (3) ◽  
pp. 361-369 ◽  
Author(s):  
Susanne Bensler ◽  
Melissa Walde ◽  
Michael A Fischer ◽  
Christian WA Pfirrmann ◽  
Cynthia K Peterson ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Ct Guided ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Transforaminal Approach ◽  
Pain Scores ◽  
Numerical Rating ◽  
Epidural Steroid

Background The study describes the difference of pain reduction in interlaminar and transforaminal injections. Purpose To compare treatment outcomes after interlaminar versus transforaminal epidural steroid injections in patients with disc herniations at the level L3/4–L5/S1 and analyze associated magnetic resonance imaging (MRI) findings. Material and Methods This retrospective comparative effectiveness outcome study included 198 patients with computed tomography (CT)-guided interlaminar (n = 99) or transforaminal (n = 99) epidural injections with particulate steroids. Pain levels at baseline and one day, one week, and one month after injection were assessed using the 11-point Numerical Rating Scale for Pain. Overall improvement was assessed after one day, one week, and one month using the Patients Global Impression of Change. MRI analysis was performed by two radiologists. Student’s t-test, Chi-square test, and Fisher’s exact test were calculated. Results Baseline pain scores were equal for interlaminar and transforaminal injections (6.23, SD = 2.10 vs. 5.84, SD = 2.02; P = 0.18). There were no significant differences in improvement between the interlaminar and transforaminal approach of epidural steroid injections after one day (30.5% vs. 21.2%, P = 0.432), one week (41.7% vs. 40.8%, P = 1.000), and one month (53.3% vs. 43.9%, P = 0.322), but there was a trend towards better effect of interlaminar injections at one day and one month. The change in Numerical Rating Scale for Pain scores showed no significant differences between the two cohorts after one day, one week, and one month ( P ≥ 0.115). None of the MR findings predicted a better or worse outcome ( P ≥ 0.171). Conclusion Interlaminar and transforaminal injections with particulate corticosteroids were equally effective, with a non-significant advantage of interlaminar injections at one day and one month. None of the MR findings were associated with treatment outcomes.

scholarly journals Immediate Pain Response Does Not Predict Long-Term Outcome of CT-Guided Cervical Transforaminal Epidural Steroid Injections

2013 ◽  
Vol 34 (8) ◽  
pp. 1665-1668 ◽  
Author(s):  
J.T. Wald ◽  
T.P. Maus ◽  
J.R. Geske ◽  
F.E. Diehn ◽  
T.J. Kaufmann ◽  
...  
Keyword(s):  
Pain Response ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Ct Guided ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Epidural Steroid
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