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Delaney FT, MacMahon PJ. An update on epidural steroid injections: is there still a role for particulate corticosteroids? Skeletal Radiol 2023; 52:1863-1871. [PMID: 36171350 DOI: 10.1007/s00256-022-04186-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 02/02/2023]
Abstract
Epidural steroid injections (ESIs) play an important role in the multifaceted management of neck and back pain. Corticosteroid preparations used in ESIs may be considered "particulate" or "non-particulate" based on whether they form a crystalline suspension or a soluble clear solution, respectively. In the past two decades, there have been reports of rare but severe and permanent neurological complications as a result of ESI. These complications have principally occurred with particulate corticosteroid preparations when using a transforaminal injection technique at cervical or thoracic levels, and only rarely in the lumbosacral spine. As a result, some published clinical guidelines and recommendations have advised against the use of particulate corticosteroids for transforaminal ESI, and the FDA introduced a warning label for injectable corticosteroids regarding the risk of serious neurological adverse events. There is growing evidence that the efficacy of non-particulate corticosteroids for pain relief and functional improvement after ESI is non-inferior to particulate agents, and that non-particulate injections almost never result in permanent neurological injury. Despite this, particulate corticosteroids continue to be routinely used for transforaminal epidural injections. More consistent clinical guidelines and societal recommendations are required alongside increased awareness of the comparative efficacy of non-particulate agents among specialists who perform ESIs. The current role for particulate corticosteroids in ESIs should be limited to caudal and interlaminar approaches, or transforaminal injections in the lumbar spine only if initial non-particulate ESI resulted in a significant but short-lived improvement.
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Affiliation(s)
- Francis T Delaney
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland.
| | - Peter J MacMahon
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
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2
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William J, Roehmer C, Mansy L, Kennedy DJ. Epidural Steroid Injections. Phys Med Rehabil Clin N Am 2022; 33:215-231. [DOI: 10.1016/j.pmr.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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3
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Cohen SP, Greuber E, Vought K, Lissin D. Safety of Epidural Steroid Injections for Lumbosacral Radicular Pain: Unmet Medical Need. Clin J Pain 2021; 37:707-717. [PMID: 34265792 PMCID: PMC8360670 DOI: 10.1097/ajp.0000000000000963] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/27/2021] [Accepted: 06/17/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Epidural steroid injections (ESIs) are a commonly utilized treatment for lumbosacral radicular pain caused by intervertebral disc herniation or stenosis. Although effective in certain patient populations, ESIs have been associated with serious complications, including paralysis and death. In 2014, the US Food and Drug Administration (FDA) issued a safety warning on the risk of injecting corticosteroids into the epidural space. The aims of this article were to review the neurological complications associated with ESIs and to compare the formulations, safety, and effectiveness of commercially available corticosteroids given by transforaminal, interlaminar, or caudal injection. METHODS Serious adverse events associated with ESIs were identified by a search of the FDA Adverse Event Reporting System (FAERS) database. A MEDLINE search of the literature was conducted to identify clinical trials comparing the safety and effectiveness of nonparticulate and particulate corticosteroid formulations. RESULTS Neurological complications with ESIs were rare and more often associated with the use of particulate corticosteroids administered by transforaminal injection. Among the 10 comparative-effectiveness studies reviewed, 7 found nonparticulate steroids had comparable efficacy to particulate steroids, and 3 studies suggested reduced efficacy or shorter duration of effect for nonparticulate steroids. DISCUSSION The risk of complications for transforaminal ESI is greater with particulate corticosteroids. Nonparticulate corticosteroids, which are often recommended as first-line therapy, may have a short duration of effect, and many commercial formulations contain neurotoxic preservatives. The safety profile of ESIs may continue to improve with the development of safer, sterile formulations that reduce the risk of complications while maintaining efficacy.
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Affiliation(s)
- Steven P. Cohen
- Johns Hopkins School of Medicine, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD
| | | | - Kip Vought
- Scilex Pharmaceuticals Inc., Palo Alto, CA
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Kwak S, Jang SH, Chang MC. Long-term outcomes of transforaminal epidural steroid injection in patients with lumbosacral radicular pain according to the location, type, and size of herniated lumbar disc. Pain Pract 2021; 21:836-842. [PMID: 33973363 DOI: 10.1111/papr.13029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/14/2021] [Accepted: 05/04/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Transforaminal epidural steroid injection (TFESI) is widely used to manage lumbosacral radicular pain due to herniated lumbar disc (HLD). OBJECTIVES We evaluated the long-term outcomes of TFESI in patients with lumbosacral radicular pain due to an HLD by the location, type, and size of the HLD. METHODS In total, 114 patients who received the initial TFESI at least 4 years ago completed a telephone interview. We investigated the presence of radicular pain, degree of current pain, current pain medications and TFESIs, additional TFESIs, progression to surgery, and trouble in performing daily life activities and occupational job duties. We classified the included patients by the location, type, and size of the HLD, and evaluated whether these factors affected the long-term outcomes of TFESI. RESULTS At least 4 years after the initial TFESI, radicular pain was completely resolved in 45% of the patients. However, 30% patients were on oral painkillers or repetitive TFESIs or had undergone surgery and 15% had difficulty in performing daily life activities and occupational job duties. A larger number of patients with extruded lumbar disc herniation required additional TFESIs than those with protruded lumbar disc herniation. Apart from this, the outcomes did not significantly differ by the location, type, and size of the HLD. CONCLUSIONS Our findings provide useful information to clinicians managing radicular pain due to HLD.
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Affiliation(s)
- Soyoung Kwak
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Korea
| | - Seung Hwa Jang
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Korea
| | - Min Cheol Chang
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Korea
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Wei WB, Dang SJ, Wei L, Liu T, Wang J. Transforaminal epidural steroid injection combined with radio frequency for the treatment of lumbar disc herniation: a 2-year follow-up. BMC Musculoskelet Disord 2021; 22:347. [PMID: 33845819 PMCID: PMC8042724 DOI: 10.1186/s12891-021-04209-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 03/31/2021] [Indexed: 11/10/2022] Open
Abstract
Background To assess the therapeutic efficacy of transforaminal epidural steroid injection (TFESI) combined with radio frequency (RF) for the treatment of lumbar disc herniation (LDH). Methods A total of 230 patients participated in the study: TFESI (Group T, n = 110), TFESI combined with RF (Group TR, n = 120). Visual analogue scale (VAS), Oswestry disability index (ODI) and Global perceived effect (GPE) scale were measured pre-operation, 1, 3, 6, 12 and 24 months after the operation. Hospitalization time, treatment time, complications, and recurrence were compared between the two groups. Results The VAS and ODI at each observation point of the post-operation were significantly decreased compared with the pre-operation in both groups (P < 0.05). There was no statistically difference of VAS and ODI between the two groups at 1 and 3 months of the post-operation (P > 0.05). However, The VAS and ODI scores in Group TR were significantly lower than that in Group T at 6, 12 and 24 months of the post-operation (P < 0.05). The GPE in group TR was high in the early days, while that at 1 and 3 months after treatment was significantly higher than that in group T (P < 0.05). The recurrence rate in Group TR was lower than that in Group T (P = 0.002). There was no significant difference in hospitalization time, complications, VAS and ODI score at the pre-operation between the two groups (P > 0.05). Conclusion These findings suggest that TFESI combined with RF could effectively improve the pain and function, and had a long-term satisfactory effect for the treatment of LDH.
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Affiliation(s)
- Wen-Bo Wei
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, The Key Laboratory of Neuro-informatics & Rehabilitation Engineering of Ministry of Civil Affairs, and Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, P. R. China.,National Engineering Research Center of Health Care and Medical Devices, Guangzhou, China.,Department of orthopedics, Shaanxi Provincial people's Hospital, Xi'an, Shaanxi, China
| | - Sha-Jie Dang
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, The Key Laboratory of Neuro-informatics & Rehabilitation Engineering of Ministry of Civil Affairs, and Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, P. R. China.,National Engineering Research Center of Health Care and Medical Devices, Guangzhou, China.,Department of Anesthesia, Shaanxi Provincial Cancer Hospital, Xi'an, Shaanxi, China
| | - Ling Wei
- Department of Pain, YangLing Demonstration Zone Hospital, Yangling, Shaanxi, China
| | - Tian Liu
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, The Key Laboratory of Neuro-informatics & Rehabilitation Engineering of Ministry of Civil Affairs, and Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, P. R. China. .,National Engineering Research Center of Health Care and Medical Devices, Guangzhou, China.
| | - Jue Wang
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, The Key Laboratory of Neuro-informatics & Rehabilitation Engineering of Ministry of Civil Affairs, and Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, P. R. China. .,National Engineering Research Center of Health Care and Medical Devices, Guangzhou, China.
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Bard H, Marty M, Rozenberg S, Laredo JD. Epidural corticosteroid injections: Still credible? Joint Bone Spine 2019; 86:531-534. [DOI: 10.1016/j.jbspin.2019.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2019] [Indexed: 01/28/2023]
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Smith CC, McCormick ZL, Mattie R, MacVicar J, Duszynski B, Stojanovic MP. The Effectiveness of Lumbar Transforaminal Injection of Steroid for the Treatment of Radicular Pain: A Comprehensive Review of the Published Data. PAIN MEDICINE 2019; 21:472-487. [DOI: 10.1093/pm/pnz160] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Abstract
Objective
To determine the effectiveness of lumbar transforaminal injection of steroid for the treatment of radicular pain.
Design
Comprehensive systematic review.
Outcome Measures
The primary outcome of interest was the proportion of individuals with reduction of pain by ≥50%. Additional outcomes of interest were a more-than-two-point reduction in pain score, patient satisfaction, functional improvement, decreased use of pain medication, and avoidance of spinal surgery.
Results
For patients with disc herniations, using the criterion of ≥50% reduction in pain, success rates across included studies (range) were 63% (58–68%) at one month, 74% (68–80%) at three months, 64% (59–69%) at six months, and 64% (57–71%) at one year. For patients with lumbar spinal stenosis, success rates across included studies (range) were 49% (43–55%) at one month, 48% (35–61%) at three months, 43% (33–53%) at six months, and 59% (45–73%) at one year, but there was a lack of corroboration from appropriately controlled studies.
Conclusions
There is strong evidence that lumbar transforaminal injection of steroids is an effective treatment for radicular pain due to disc herniation. There is a lack of high-quality evidence demonstrating their effectiveness for the treatment of radicular pain due to spinal stenosis, though small studies suggest a possible benefit. Lumbar transforaminal injection of nonparticulate steroids is as effective as injections with particulate steroids.
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Affiliation(s)
- Clark C Smith
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Zachary L McCormick
- Division of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah
| | - Ryan Mattie
- Providence Cedars-Sinai Tarzana Hospital, Providence Specialty Medical Group, Comprehensive Spine & Interventional Pain Management, Tarzana, California
| | | | | | - Milan P Stojanovic
- Anesthesiology, Critical Care and Pain Medicine Service, VA Boston Healthcare System, Harvard Medical School, Boston, Massachusetts, USA
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8
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Epidural steroid and local anaesthetic injection for treating pain caused by coccygeal intervertebral disc protrusion in a dog. Vet Anaesth Analg 2019; 46:707-708. [PMID: 31277937 DOI: 10.1016/j.vaa.2019.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/05/2019] [Accepted: 04/15/2019] [Indexed: 11/24/2022]
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Kennedy DJ, Zheng PZ, Smuck M, McCormick ZL, Huynh L, Schneider BJ. A minimum of 5-year follow-up after lumbar transforaminal epidural steroid injections in patients with lumbar radicular pain due to intervertebral disc herniation. Spine J 2018; 18:29-35. [PMID: 28962912 DOI: 10.1016/j.spinee.2017.08.264] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 08/02/2017] [Accepted: 08/28/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Patients with lumbosacral radiculopathy from an intervertebral disc herniation are frequently treated by transforaminal epidural steroid injections (TFESIs). The long-term outcomes of these patients are poorly described. PURPOSE We aimed to determine the long-term outcomes for a homogenous group of patients with acute unilateral lumbar radicular pain due to single-level herniated nucleus after lumbar epidural steroid injection at ≥5 years. DESIGN This is a prospective cohort study. PATIENT SAMPLE Subjects enrolled into a previous reported multi-institutional randomized controlled trial, ≥18 years old with single leg radicular pain rating ≥4/10 for less than 6 months' duration, with radiographic imaging demonstrating an anatomically congruent single-level herniated nucleus pulposus. OUTCOME MEASURES Presence of recurrent or persistent pain, pain within the previous week, current opioid use for radicular symptoms, additional spine injections for radicular pain, progression to surgery, and unemployment due to pain as determined by independent phone interview at least 5 years after enrolment due to the initial pain complaint were the outcome measures. METHODS All patients initially underwent a single-level lumbar TFESIs due to failure of conservative care, but could elect to pursue surgical intervention or repeat injections through shared decision making with the treating physician when and if pain control was deemed inadequate. After ≥5 years, an independent assessor contacted the subjects by phone and performed a standardized interview to determine outcomes. Fisher exact test was used to compare outcomes for those who pursued versus those who did not pursue surgery. RESULTS During the recruitment period (December 2008 to December 2012), 78 subjects were enrolled. At 5 years, 39 (50%) of the 78 subjects were reachable for independent phone follow-up. Of these, 30 (76.9%, 95% confidence interval [CI] 61.7%-87.4%) had a history of recurrent pain since the initial TFESI. However, only 9 (23.1%, 95% CI 12.7%-38.3%) had current pain, while 3 (7.7%, 95% CI 2.7%-20.3%) were currently taking opioid medications. Nine (23.1%, 95% CI 12.7%-38.3%) had received additional TFESIs, and 19 (48.7%, 95% CI 33.9%-63.8%) had received surgery. Only 3 (7.7%, 95% CI 2.7%-20.3%) were unemployed due to related pain at time of follow-up. When comparing the group that had surgery versus those that did not, there were no differences in the rates of recurrent pain (16, 84.2% vs. 14, 70.0%, p=.81), current pain (6, 31.6% vs. 3, 15.0%, p=.47), opioid use (2, 10.5% vs. 1, 5.0%, p=1.00), rate of additional injections (6, 31.6% vs. 3, 15.0%, p=.47), or unemployment status (2, 10.5% vs. 1, 5.0%, p=1.00). CONCLUSIONS Despite a high success rate at 6 months, the majority of subjects experienced a recurrence of symptoms at some time during the subsequent 5 years. Fortunately, few reported current symptoms, and a small minority required additional injections, surgery, or opioid pain medications. Lumbar disc herniation is a disease that can be effectively treated in the short-term by TFESI or surgery, but long-term recurrence rates are high regardless of treatment received.
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Affiliation(s)
- David J Kennedy
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway St, Pavilion C, MC 6342, Redwood City, CA 94063, USA.
| | - Patricia Z Zheng
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway St, Pavilion C, MC 6342, Redwood City, CA 94063, USA
| | - Matthew Smuck
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway St, Pavilion C, MC 6342, Redwood City, CA 94063, USA
| | - Zachary L McCormick
- Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, 30 North 1900 East, Salt Lake City, UT 84132, USA
| | - Lisa Huynh
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway St, Pavilion C, MC 6342, Redwood City, CA 94063, USA
| | - Byron J Schneider
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, 2201 Children's Way Nashville, TN 37212, USA
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Orduña-Valls JM, Nebreda-Clavo CL, López-Pais P, Torres-Rodríguez D, Quintans-Rodríguez M, Álvarez-Escudero J. Characteristics of particulate and non-particulate corticosteroids. Indications for their use in chronic pain treatments. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2016; 63:333-346. [PMID: 26948384 DOI: 10.1016/j.redar.2016.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 12/23/2015] [Accepted: 01/11/2016] [Indexed: 06/05/2023]
Abstract
Corticosteroids been used frequently in pain treatments since the middle of last century (1952). Due to a review of the complications as a result of their application in epidural injections, the United States of America Food and Drug Administration (FDA) issued an «alert controversy» requesting that a warning label should be added to injectable corticosteroids, where risks must be described (loss of sight, brain damage, paralysis and death) when administering by this route. It must be mentioned that there are different types of corticosteroids with diverse characteristics, which as a result, may produce different side-effects. Due to the aforementioned developments, the controversies that have arisen, and the lack of well-conducted studies on the use of steroids in epidural injections, we must begin by reviewing their indications in different pain conditions.
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Affiliation(s)
- J M Orduña-Valls
- Servicio de Anestesiología Reanimación y Tratamiento del Dolor, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España.
| | - C L Nebreda-Clavo
- Servicio de Anestesiología Reanimación y Tratamiento del Dolor, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - P López-Pais
- Servicio de Anestesiología Reanimación y Tratamiento del Dolor, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | | | - M Quintans-Rodríguez
- Departamento de Ciencias Morfológicas, Universidad de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - J Álvarez-Escudero
- Servicio de Anestesiología Reanimación y Tratamiento del Dolor, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
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Schneider B, Zheng P, Mattie R, Kennedy DJ. Safety of epidural steroid injections. Expert Opin Drug Saf 2016; 15:1031-9. [DOI: 10.1080/14740338.2016.1184246] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Byron Schneider
- Department of Orthopedics, Division of Physical Medicine and Rehabilitation, Stanford University, Redwood City, CA, USA
| | - Patricia Zheng
- Department of Orthopedics, Division of Physical Medicine and Rehabilitation, Stanford University, Redwood City, CA, USA
| | - Ryan Mattie
- Department of Orthopedics, Division of Physical Medicine and Rehabilitation, Stanford University, Redwood City, CA, USA
| | - David J. Kennedy
- Department of Orthopedics, Division of Physical Medicine and Rehabilitation, Stanford University, Redwood City, CA, USA
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De Luigi AJ, Kennedy DJ. Safety Implications for Lumbar Epidural Injections: Caudal, Interlaminar, and Transforaminal Approaches. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2016. [DOI: 10.1007/s40141-016-0116-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Watkins TW, Dupre S, Coucher JR. Ropivacaine and dexamethasone: a potentially dangerous combination for therapeutic pain injections. J Med Imaging Radiat Oncol 2015; 59:571-7. [DOI: 10.1111/1754-9485.12333] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 05/11/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Trevor William Watkins
- Department of Medical Imaging; Princess Alexandra Hospital; Brisbane Queensland Australia
- University of Queensland; Brisbane Queensland Australia
| | - Simon Dupre
- Department of Medical Imaging; Nambour General Hospital; Nambour Queensland Australia
- University of Queensland; Brisbane Queensland Australia
| | - John Richard Coucher
- Department of Medical Imaging; Princess Alexandra Hospital; Brisbane Queensland Australia
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Ideal Cervical Epidural Injection Route: Interlaminar or Transforaminal. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2015. [DOI: 10.1007/s40141-015-0084-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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15
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Schneider B, Varghis N, Kennedy DJ. Ideal Corticosteroid Choice for Epidural Steroid Injections: A Review of Safety and Efficacy. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2015. [DOI: 10.1007/s40141-015-0086-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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16
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McCormick ZL, Kennedy DJ. Truth in Medicine: Why Most Reviews and Commentaries on Spine Treatments are Flawed. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2015. [DOI: 10.1007/s40141-015-0080-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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