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Hao D, Yong RJ, Narouze S, Fogarty AE, Sutton OM, Stojanovic MP. Epidural Glucocorticoid Injection for Lumbosacral Radicular Pain. N Engl J Med 2024; 391:e38. [PMID: 39504522 DOI: 10.1056/nejmvcm2313448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2024]
Affiliation(s)
- David Hao
- From the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston
| | - R Jason Yong
- From the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston
| | - Samer Narouze
- From the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston
| | - Alexandra E Fogarty
- From the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston
| | - Olivia M Sutton
- From the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston
| | - Milan P Stojanovic
- From the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston
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Huang H, Yang M, Fu Z, Hu H, Wu C, Tan L. Predicting and analysing of the unfavourable outcomes of early applicated percutaneous endoscopic interlaminar discectomy for lumbar disc herniation: development and validation based nomogram. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:906-914. [PMID: 38342841 DOI: 10.1007/s00586-024-08141-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/13/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVE To predict and analyse the unfavourable outcomes of early applicated percutaneous endoscopic interlaminar discectomy for lumbar disc herniation. METHODS Information of 426 patients treated by early applicated percutaneous endoscopic interlaminar discectomy (PEID) for lumbar disc herniation (LDH) at our hospital from June 2017 to October 2021 in addition to 17 other features was collected. The risk factors were selected by the least absolute shrinkage and selection operator method (LASSO) regression. Then, a prediction model (nomogram) was established to predict the unfavourable outcomes of using the risk factors selected from LASSO regression. Bootstrap (n = 1000) was used to perform the internal validation, and the performance of the model was assessed by the concordance index (C-index), receiver operating characteristic curve, and calibration curve. The decision curve analysis (DCA) and clinical impact curve (CIC) were used to assess the clinical utility of the model, respectively. RESULTS Finally, 53 of 426 patients showed unfavourable outcomes. Five potential factors, Modic change, Calcification, Lumbar epidural steroid injection preoperative, Articular process hyperplasia and cohesion, and Laminoplasty technique, were selected according to the LASSO regression, that identified the predictors to establish nomogram model. Meanwhile, the C-index of the prediction nomogram was 0.847, the area under the receiver operating characteristic curve value was 0.847, and the interval bootstrapping (n = 1000) validation C-index was 0.809. The model has good practicability for clinics according to the DCA and CIC. CONCLUSION This nomogram model has good predictive performance and clinical practicability, which could provide a certain basis for predicting unfavourable outcomes of early applicated PEID for LDH.
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Affiliation(s)
- Huiyu Huang
- Emergency Department, Zigong Fourth People's Hospital, Zigong, China.
| | - Min Yang
- Neurology Department, Zigong First People's Hospital, Zigong, China
| | - Zhaojun Fu
- Emergency Department, Zigong Fourth People's Hospital, Zigong, China
| | - Haigang Hu
- Orthopaedic Center, Zigong Fourth People's Hospital, Zigong, China
| | - Chao Wu
- Orthopaedic Center, Zigong Fourth People's Hospital, Zigong, China
- Digital Medical Center, Zigong Fourth People's Hospital, Zigong, China
| | - Lun Tan
- Orthopaedic Center, Zigong Fourth People's Hospital, Zigong, China
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Fogarty AE, Wilson A, Godambe M, Shinde N, Gou C, Decker G, Steensma J. The carbon footprint of epidural steroid injections: A pilot study. PM R 2023. [PMID: 38037489 DOI: 10.1002/pmrj.13111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/22/2023] [Accepted: 11/11/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Epidural steroid injections are common procedures in physical medicine and rehabilitation practice. However, their environmental impact has not been characterized. OBJECTIVE The primary aim is to estimate and compare the carbon footprint of two standard injection kits used to perform epidural steroid injections at a single academic institution. Secondary objectives were (1) to create a step-by-step guide for estimating the carbon footprint of materials and (2) to survey physicians on practice patterns and identify areas for improvement. DESIGN Pilot study. SETTING Academic medical center. PARTICIPANTS N/A. INTERVENTIONS N/A. OUTCOME MEASURES Carbon emissions measured in CO2 equivalents (CO2 eq). METHODS Using guidance from the Greenhouse Gas Protocol, the carbon footprint of the two kits was estimated by taking the sum of carbon emissions resulting from the production of the kit materials and the carbon emissions resulting from the waste disposal of the kit materials. RESULTS The carbon footprint of the transforaminal epidural steroid injection (TFESI) kit was estimated at 1.328 kg CO2 eq. The carbon footprint of the interlaminar epidural steroid injection (ILESI) kit was estimated at 2.534 kg CO2 eq. For both kits, the carbon emissions resulting from the production of the kits were greater than the emissions resulting from disposal. The survey of interventionalists performing TFESI revealed all respondents required materials in addition to those provided in the standard epidural kit. Despite this, kit materials were typically wasted in 62% of respondents. CONCLUSION Creating a methodology for quantifying carbon emissions is the first step to reducing carbon emissions. Once emissions are measured, the health care industry can determine the most effective strategies for reducing its impact. Our analysis has shown that it is feasible to perform emissions calculations and delineates a clear method with publicly available resources. Solutions to reduce epidural injection carbon footprint waste may include improved kit customization.
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Affiliation(s)
- Alexandra E Fogarty
- Department of Orthopaedic Surgery, Division of Physical Medicine & Rehabilitation, Washington University School of Medicine, Campus Box 8233, Saint Louis, Missouri, USA
| | - Annalee Wilson
- Brown School, Washington University in St. Louis, One Booking Drive, Campus Box 1196, St. Louis, Missouri, USA
| | - Maya Godambe
- Brown School, Washington University in St. Louis, One Booking Drive, Campus Box 1196, St. Louis, Missouri, USA
| | - Nidhi Shinde
- Brown School, Washington University in St. Louis, One Booking Drive, Campus Box 1196, St. Louis, Missouri, USA
| | - Christine Gou
- Department of Orthopaedic Surgery, Division of Physical Medicine & Rehabilitation, Washington University School of Medicine, Campus Box 8233, Saint Louis, Missouri, USA
| | - Gregory Decker
- Department of Orthopaedic Surgery, Division of Physical Medicine & Rehabilitation, Washington University School of Medicine, Campus Box 8233, Saint Louis, Missouri, USA
| | - Joe Steensma
- Brown School, Washington University in St. Louis, One Booking Drive, Campus Box 1196, St. Louis, Missouri, USA
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Whitaker CD, Stone BK, Gregorczyk JA, Alsoof D, Hardacker K, Diebo BG, Daniels A, Basques B. Nonsurgical Interventional Spine Pain Procedures: Outcomes and Complications. JBJS Rev 2023; 11:01874474-202304000-00003. [PMID: 37058581 DOI: 10.2106/jbjs.rvw.22.00235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
» Nonsurgical interventional spine pain procedures provide an additional treatment option for lower back pain at the traditional bifurcation of conversative vs. operative management. » Transforaminal epidural steroid injections, radiofrequency ablations, intrathecal drug delivery, and spinal cord stimulation were found to be effective and safe techniques when applied to their specific indication. » Thermal annuloplasty and minimally invasive lumbar decompression showed mixed support. » Discography, sacroiliac joint injections, and spinous process spacers lacked sufficient evidence to support efficacy. » Medial branch blocks and facet joint injections were found to be useful diagnostic tools.
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Affiliation(s)
- Colin D Whitaker
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Benjamin K Stone
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | | | - Daniel Alsoof
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Kyle Hardacker
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Bassel G Diebo
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Alan Daniels
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Bryce Basques
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
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Kartavykh RA, Yusupova AR, Gushcha AO. [Modern aspects to the diagnosis and non-surgical treatment of low back pain]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2023; 87:106-113. [PMID: 38054234 DOI: 10.17116/neiro202387061106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Low back pain is one of the most common complaints in primary care. This pain is usually nonspecific and musculoskeletal. However, identification and exclusion of specific causes of pain as early as possible are important for specialists since their underestimation can sometimes lead to life-threatening consequences. The authors analyze literature data on the key facts of anamnesis («red flags»), management of patients with low back pain with emphasis on modern concepts and recommendations for diagnostics, identifying the dominant nature and cause of pain, differential diagnosis, and diagnostic significance of neuroimaging. Special attention is paid to existing options for conservative (drug and non-drug therapy) and interventional treatment methods, which have become increasingly popular in recent years.
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Affiliation(s)
| | | | - A O Gushcha
- Research Center of Neurology, Moscow, Russia
- Russian Medical Academy of Continuing Professional Education, Moscow, Russia
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Ratnasamy PP, Gouzoulis MJ, Kammien AJ, Holder EK, Grauer JN. Changes in the Utilization of Lumbosacral Epidural Injections Between 2010 and 2019. Spine (Phila Pa 1976) 2022; 47:1669-1674. [PMID: 36281568 PMCID: PMC9643603 DOI: 10.1097/brs.0000000000004467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/17/2022] [Indexed: 11/06/2022]
Abstract
STUDY DESIGN A descriptive epidemiologic study. OBJECTIVE To analyze trends and patient characteristics for lumbosacral transforaminal and interlaminar/caudal epidural injection utilization over time. BACKGROUND Lumbosacral transforaminal and interlaminar/caudal epidural injections are considered for varying lumbar pathologies. Reported studies, physician practices, insurance authorization, and other factors may influence utilization patterns over time. METHODS Patients undergoing lumbosacral transforaminal and interlaminar/caudal epidural injections between 2010 and 2019 were identified in the M91Ortho PearlDiver database based on Current Procedural Terminology coding. Patient age, sex, Elixhauser Comorbidity Index (ECI), insurance plan (commercial, Medicaid, Medicare), and region of the country where the procedure was performed (Midwest, Northeast, South, West) were assessed and tracked over the years studied based on prevalence per 100,000 covered lives. RESULTS Lumbosacral transforaminal and interlaminar/caudal epidural injections were identified for 426,039 and 501,228 patients, respectively. The number of injections performed per year decreased over the years studied: for transforaminal injections from 160.81 to 76.36 per 100,000 patients and for interlaminar/caudal injections from 200.53 to 77.56 per 100,000 patients. The decrease in overall injections was greatest for those with Commercial and Medicare coverage (53.40% and 66.50%, respectively), with a smaller drop amongst those with Medicaid coverage (32.39%).Over the years, the average patient undergoing injection was older and there was a relative shift toward transforaminal injections ( P <0.05 for both). In terms of specialty of those performing the injections, they were mostly performed by Anesthesiology specialists (who performed less transforaminal than interlaminar/caudal injections). CONCLUSION Lumbosacral transforaminal and interlaminar/caudal spinal epidural injections were shown to decrease by 52.37% per 100,000 patients from 2010 to 2019. Changing demographics of those undergoing such injections and practice patterns are important to consider in the picture of overall spine service utilization. Variations in injection utilization trends by patient insurance raise questions regarding disparities in care.
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Affiliation(s)
- Philip P Ratnasamy
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT
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Yazici Sacaklidir G, Sencan S, Sacaklidir R, Gunduz OH. The effect of spinopelvic parameters on transforaminal epidural steroid injection treatment success in lumbar disc herniation. Int J Clin Pract 2021; 75:e14708. [PMID: 34370361 DOI: 10.1111/ijcp.14708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/06/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Spinopelvic parameters (SPP) is closely associated with diseases such as lumbar disc herniation (LDH), disc degeneration and spondylolisthesis. Although there exist many known clinical and radiological factors affecting the success of the transforaminal epidural steroid injection (TFESI) treatment, the effect of SPP has not yet been investigated. This study aims to examine the effects of SPP on treatment success in patients who undergo TFESI because of lumbar disc herniation and to investigate the correlation among multifidus cross-sectional area (MFCSA). METHODS This was a prospective, observational study. Patients with low back and/or leg pain, unilateral nerve root compression were applied TFESI. Outcome measures included the numerical rating scale (NRS), Oswestry Disability Index (ODI) and Beck Depression Inventory (BDI). The patients were evaluated at the first hour, third week and third month. The SPP and MFCSA measurements were made on direct radiographs and MRIs. RESULTS A total of 58 patients, 24 women and 34 men, with an average age of 42.0 ± 9.5 were included. NRS, ODI and BDI scores improved significantly up to three months follow-up (P < .001). Moderately positive correlations were found between leg NRS and PT/PI scores immediately after treatment (r: 0.307 and r: 0.334) and a weak positive correlation was found between BDI and PT at third week (r: 0.269). The MFCSA/vertebral sectional area (VSA) and MFCSA/total multifidus cross-sectional area (TMFCSA) of the affected side was found to be significantly low (P < .001). CONCLUSIONS Subjects with high PI and PT reported less improvement in leg pain immediately after treatment and patients with high PT had fewer BDI improvements. MFCSA had no correlations with SPPs in patients who underwent TFESI.
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Affiliation(s)
- Gonca Yazici Sacaklidir
- Department of Physical Medicine and Rehabilitation, Sureyyapasa Chest Diseases and Thoracic Surgery Training Hospital, İstanbul, Turkey
| | - Savas Sencan
- Division of Pain Medicine, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Marmara University, İstanbul, Turkey
| | - Rekib Sacaklidir
- Division of Pain Medicine, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Marmara University, İstanbul, Turkey
| | - Osman Hakan Gunduz
- Division of Pain Medicine, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Marmara University, İstanbul, Turkey
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Wang Y, Wang AZ, Wu BS, Zheng YJ, Zhao DQ, Liu H, Xu H, Fang HW, Zhang JY, Cheng ZX, Wang XR. Chinese Association for the Study of Pain: Experts consensus on ultrasound-guided injections for the treatment of spinal pain in China (2020 edition). World J Clin Cases 2021; 9:2047-2057. [PMID: 33850924 PMCID: PMC8017500 DOI: 10.12998/wjcc.v9.i9.2047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/31/2021] [Accepted: 03/16/2021] [Indexed: 02/06/2023] Open
Abstract
Spinal pain (SP) is a common condition that has a major negative impact on a patient’s quality of life. Recent developments in ultrasound-guided injections for the treatment of SP are increasingly being used in clinical practice. This clinical expert consensus describes the purpose, significance, implementation methods, indications, contraindications, and techniques of ultrasound-guided injections. This consensus offers a practical reference point for physicians to implement successfully ultrasound-guided injections in the treatment of chronic SP.
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Affiliation(s)
- Yun Wang
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Ai-Zhong Wang
- Department of Anesthesiology, The Sixth Affiliated People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Bai-Shan Wu
- Department of Algology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yong-Jun Zheng
- Department of Algology, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Da-Qiang Zhao
- Department of Anesthesiology, Jiahui International Hospital, Shanghai 200233, China
| | - Hui Liu
- Department of Algology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Hua Xu
- Department of Anesthesiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Hong-Wei Fang
- Department of Algology, East Hospital, Tongji University, Shanghai 200120, China
| | - Jin-Yuan Zhang
- Department of Algology, East Hospital, Tongji University, Shanghai 200120, China
| | - Zhi-Xiang Cheng
- Department of Algology, The Second Affiliated Hospital, Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
| | - Xiang-Rui Wang
- Department of Algology, East Hospital, Tongji University, Shanghai 200120, China
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Budisulistyo T, Atmaja F. Percutaneous Discectomy Followed by CESI Might Improve Neurological Disorder of Drop Foot Patients Due to Chronic LDH. Brain Sci 2020; 10:brainsci10080539. [PMID: 32796497 PMCID: PMC7465042 DOI: 10.3390/brainsci10080539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/15/2020] [Accepted: 07/17/2020] [Indexed: 01/23/2023] Open
Abstract
(1) Introduction: Epiconus and conus medullary syndromes that consisted of drop foot, pain, numbness, bladder or bowel dysfunction are serious problems might be caused by lumbar disc(s) herniation (LDH) compression. (2) Objective: To evaluate percutaneous discectomy effectivity for decompressing LDH lesions. (3) Case Report: Three patients suffered from drop feet, numbness, and bowel and bladder problems due to LDH compression. Patient #1 is a male (35 years old, basal metabolism index (BMI) = 23.9), point 1 on manual muscle test (MMT), with protrusion on L3 to S1 discs; Patient #2 is a female (62 years old, BMI = 22.4), point 3 on MMT, with protrusion on L2-4 and L5-S1 discs; Patient #3 is a female (43 years old, BMI = 26.6), point 4 on MMT, with extrusion on T12-L1 and L1-2 and L3-4 protruded discs. Six months follow-up showed of stand and walkability improvement with Patient #1 and #2. Patient #3 showed improvement in bowel and bladder problems within 10 weeks, without suffering of postoperative pain syndromes. (4) Discussion: Patient #1 and #2 showed better outcomes than Patient #3 who affected epiconus and cauda equina syndromes. Triamcinolone and lidocaine have analgesic and anti-inflammatory properties for improving intraepidural circulation adjacent to the lesion sites. (5) Conclusion: Drop foot caused by mechanical compression of LDH ought to be treated immediately. Lateral or posterolateral compression has better outcomes associated with anatomical structures. Discectomy through transforaminal approach that is followed by caudal epidural steroid injection (CESI) under fluoroscopic guidance is a safer and minimally invasive treatment with promising outcomes.
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Affiliation(s)
- Trianggoro Budisulistyo
- Department of Neurology, Diponegoro Univ/Dr.Kariadi Hospital, Semarang 50244, Indonesia
- Correspondence:
| | - Firmansyah Atmaja
- Indonesian Army Health Center/Pelamonia Hospital, Makassar 90157, Indonesia;
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Lumbar Epidural Hematoma Following Interlaminar Fluoroscopically Guided Epidural Steroid Injection. Reg Anesth Pain Med 2016; 41:402-4. [DOI: 10.1097/aap.0000000000000387] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Smith H, Youn Y, Guay RC, Laufer A, Pilitsis JG. The Role of Invasive Pain Management Modalities in the Treatment of Chronic Pain. Med Clin North Am 2016; 100:103-15. [PMID: 26614722 DOI: 10.1016/j.mcna.2015.08.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Invasive analgesic therapies provide an alternative to medical management of chronic pain. With the increasing incidence of chronic pain not only in the United States but worldwide, more therapies have evolved to address the growing need for pain relief options. These therapies include spinal injections, nerve blocks, radiofrequency ablation, neurostimulation, and intrathecal drug delivery.
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Affiliation(s)
- Heather Smith
- Department of Neurosurgery, Albany Medical Center, 47 New Scotland Avenue, MC 10, Albany, NY 12208, USA
| | - Youngwon Youn
- Department of Neurosurgery, Albany Medical Center, 47 New Scotland Avenue, MC 10, Albany, NY 12208, USA
| | - Ryan C Guay
- Department of Anesthesiology, Albany Medical Center, 47 New Scotland Avenue, MC 10, Albany, NY 12208, USA
| | - Andras Laufer
- Department of Anesthesiology, Albany Medical Center, 47 New Scotland Avenue, MC 10, Albany, NY 12208, USA
| | - Julie G Pilitsis
- Department of Neurosurgery, Albany Medical Center, 47 New Scotland Avenue, MC 10, Albany, NY 12208, USA.
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Epidural steroid injections for radicular lumbosacral pain: a systematic review. Phys Med Rehabil Clin N Am 2014; 25:471-89.e1-50. [PMID: 24787344 DOI: 10.1016/j.pmr.2014.02.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Most clinical guidelines do not recommend routine use of epidural steroid injections for the management of chronic low back pain. However, many clinicians do not adhere to these guidelines. This comprehensive evidence overview concluded that off-label epidural steroid injections provide small short-term but not long- term leg-pain relief and improvement in function; injection of steroids is no more effective than injection of local anesthetics alone; post-procedural complications are uncommon, but the risk of contamination and serious infections is very high. The evidence does not support routine use of off-label epidural steroid injections in adults with benign radicular lumbosacral pain.
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Tao X(G, Lavin RA, Yuspeh L, Bernacki EJ. Implications of Lumbar Epidural Steroid Injections After Lumbar Surgery. J Occup Environ Med 2014; 56:195-203. [DOI: 10.1097/jom.0000000000000076] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Computed Tomography-guided Periradicular Injections on Cervical and Lumbar Spine. Tech Orthop 2013. [DOI: 10.1097/bto.0b013e31828a1dc8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Effect of epidural steroid injection on bone mineral density and markers of bone turnover in postmenopausal women. Spine (Phila Pa 1976) 2012. [PMID: 23196966 DOI: 10.1097/brs.0b013e318270280e] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective, observational study. OBJECTIVE To evaluate the effect of epidural steroid injection (ESI) on bone mineral density (BMD) in postmenopausal women. SUMMARY OF BACKGROUND DATA ESIs are used to treat the pain associated with radiculopathy. Although it is known that exogenous steroid use can disrupt skeletal architecture, it is less clear whether ESIs result in a decrease of BMD. METHODS Twenty-eight postmenopausal women experiencing radiculopathy elected L4-L5 ESI treatment. We had a 50% dropout rate due to noncompliance with study requirements. BMD of the hip, femoral neck, and spine along with markers of bone turnover, bone specific-alkaline phosphatase and serum C-telopeptide of collagen I (CTX), was evaluated at baseline preinjection and 3 and 6 months postinjection. RESULTS There was a significant decline in the hip BMD of 0.018 g/cm (0.028 ± 0.007, P = 0.002) at 6 months compared with baseline. We compared this decline with an age-matched control population that exhibited a decline of 0.003 g/cm(2), significantly less than our study population (P = 0.007). Bone-specific alkaline phosphatase increased significantly by 2.33 U/L from 3 to 6 months (P = 0.012), but the rise of CTX was not significant. CONCLUSION A single ESI in postmenopausal women adversely affects BMD of the hip. This is in conjunction with a rise in bone remodeling activity, as evidenced by an increase in bone-specific alkaline phosphatase and CTX. In addition, when compared with an age-matched control population, our study population exhibited a greater decline in BMD. Our findings show that epidural administration of corticosteroids has a deleterious effect on bone, which should be considered when contemplating treatment options for radiculopathy. The resulting decrease in BMD, while slight, suggests that ESIs should be used with caution in those at a risk for fracture.
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Abstract
Epidural steroid injection (ESI) is the most commonly performed intervention in pain clinics across the United States. This article provides an evidence-based review of ESI, including data on efficacy, patient selection, comparison of types, and complications. The data strongly suggest that ESI can provide short-term relief for radicular symptoms but are less compelling for long-term effects or relief of back pain. Although it has been asserted that transforaminal ESIs are more efficacious than interlaminar injections, the evidence supporting this is limited.
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Thampi SP, Rekhala V, Vontobel T, Nukula V. Patient safety in interventional pain procedures. Phys Med Rehabil Clin N Am 2012; 23:423-32. [PMID: 22537703 DOI: 10.1016/j.pmr.2012.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The objective of this article was to present a systematic review of the safety issues encountered in interventional pain management. Patient safety is an important consideration in the practice of interventional pain management. Although there is a paucity of scientific articles addressing this topic, the authors have reviewed the literature and present a review of the topic, as well as strategies to minimize the risk to patients undergoing interventional spine procedures.
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Affiliation(s)
- Samuel P Thampi
- Department of Physical Medicine and Rehabilitation, Kingsbrook Jewish Medical Center, 585 Schenectady Avenue, Suite 224, Brooklyn, NY 11203, USA.
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Abstract
Athletes represent a specific subgroup of highly motivated patients with a unique set of social and psychological incentives. Demands placed on the lumbosacral system are high, and athletes may be particularly prone to the pathology discussed above. For this reason, it is crucial to consider the athlete as a functional whole operating in concert with intrinsic and extrinsic factors and to consider the lumbosacral system within the context of the complete kinetic chain. Spinal interventions should never be considered in isolation but rather as part of a comprehensive rehabilitation program targeting psychosocial as well as biomechanical opportunities. When interventional procedures are warranted, they should be performed according to existing guidelines regarding indication, patient selection, and technique where possible and with systems in place to maximize patient safety and to consistently monitor for response. Each of the interventions discussed above should be performed with fluoroscopic guidance, given the lack of accuracy without fluoroscopy, and generally be reserved for athletes not responding to conservative care. When returning an athlete to play after ESI, we recommend careful serial evaluation as well as involvement of appropriate family members, athletic trainers, and coaches in the decision-making process. Athletes should not return to play with any significant objective neurologic deficits. In appropriate athletes, return to play should occur with graduated and comprehensive rehabilitation as discussed above. Because evidence concerning the interventions discussed in this article is often lacking, clinical judgment is paramount regarding their allocation. The interventions explored above likely do provide viable treatment adjuncts in the carefully selected athlete but are not without risk. Athlete safety and global well being should guide any decision to pursue interventional treatment options.
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Affiliation(s)
- Daniel V Colonno
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA.
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Çok OY, Eker HE, Çok T, Akin Ş, Ariboğan A, Arslan G. Abnormal Uterine Bleeding: Is It an Under-Reported Side Effect after Epidural Steroid Injection for the Management of Low Back Pain? PAIN MEDICINE 2011; 12:986. [DOI: 10.1111/j.1526-4637.2011.01137.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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