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Transforaminal epidural steroid injection

Elon Eisenberg, Rephael Goldman, Dorit Schlag-Eisenberg, Anat Grinfeld
Lumbar epidural steroid injections (LESIs) are commonly used for managing lower back pain (LBP) and radicular pain. LESIs are generally considered safe with only rare serious complication. One very rare complication that is frequently cited in the literature is adhesive arachnoiditis. However, a literature search failed to detect even one published manuscript, clearly documenting LESI induced arachnoiditis. This article presents two patients who received a transforaminal L5-S1 and two L3-L4 interlaminar LESIs...
2019: Journal of Pain Research
Sibel Demir-Deviren, Emel E Ozcan-Eksi, Savas Sencan, Hemra Cil, Sigurd Berven
BACKGROUND: Non-surgical treatment is the primary approach to degenerative conditions of the lumbar spine and may involve multiple modalities. There is little literature to guide an evidence-based approach to care. OBJECTIVE: To determine the effectiveness of CNT (comprehensive non-surgical treatment) in patients with degenerative spondylolisthesis (DS) and spondylolytic spondylolisthesis (SS), and to identify predictor variables for success of CNT in avoiding surgery...
January 11, 2019: Journal of Back and Musculoskeletal Rehabilitation
Utku Adilay, Bulent Guclu, Levent Deniz, Ramazan Kahveci
AIM: Lumbar disc herniation is a common disease and can cause back pain and radicular pain. Some cases require surgical intervention for persistent severe pain. In other cases, transforaminal epidural steroid injection is the treatment of choice. This study compared the outcomes of fluoroscopically guided transforaminal epidural steroid injections of L4-L5 paramedian disc herniation with L5-S1 paramedian disc herniation for the treatment of radicular pain. MATERIAL AND METHODS: A total of 593 patients treated by transforaminal epidural steroid injections for the treatment of L4-5 paramedian disc herniation and 504 patients treated by transforaminal epidural steroid injections for the treatment of L5-S1 paramedian disc herniation were included in the study...
October 8, 2018: Turkish Neurosurgery
Xin Zhang, Haifeng Shi, Jin Zhou, Yongming Xu, Shaofeng Pu, Yingying Lv, Junzhen Wu, Yueping Cheng, Dongping Du
Background: Cervical transforaminal epidural steroid injection (CTFESI) is used to provide pain relief and restore function in patients with cervical radiculopathy. Traditionally, it is performed under the guidance of fluoroscopy or computed tomography. Here, we introduce a novel technique - ultrasound-guided CTFESI - with which operators can easily distinguish the close soft tissue (nerve, vessels) around the cervical foramina to avoid intravascular injection during the procedure. Objective: To present the immediate and long-term effectiveness of ultrasound-guided CTFESI in patients with cervical radiculopathy in an academic pain-management center with prospective clinic experiments...
2019: Journal of Pain Research
Tobias J Dietrich, Cynthia K Peterson, Konstantinos G Zeimpekis, Susanne Bensler, Reto Sutter, Christian W A Pfirrmann
Purpose To compare the radiation exposure for participants and interventionalists as well as participant outcomes between fluoroscopy-guided versus CT-guided lumbar spinal injections. Materials and Methods This prospective, nonrandomized observational study included 1446 participants (mean age, 60.6 years; range, 18-91 years) who received transforaminal epidural injections or facet joint injections under fluoroscopic or CT guidance between October 2009 and April 2016. Effective doses were estimated by conversion from dose-area product for fluoroscopy-guided injections and dose-length product for CT-guided injections...
January 8, 2019: Radiology
Maria Clemente, Carla Roero, Veronica Perlo, Elena Peila, Anna De Luca
INTRODUCTION: Acute lumbosacral radicular syndrome is often a medical disorder of difficult management. Epidural steroid injection is a useful approach for the herniated disc and radiculitis. The transforaminal approach is usually considered more effective and target-specific, but it can be associated with permanent lower extremity paralysis. A caudal approach with an adjustable catheter has been widely used in adhesiolysis in chronic low back pain, but there are no reports of its application in acute radicular pain...
January 8, 2019: Pain and Therapy
Jaewoo Choi, Doo Hoe Ha, Shinyoung Kwon, Youngsu Jung, Junghoon Yu, MinYoung Kim, Kyunghoon Min
OBJECTIVE: To suggest rotation angles of fluoroscopy that can bypass the carotid sheath according to vertebral levels for cervical transforaminal epidural steroid injection (TFESI). METHODS: Patients who underwent cervical spine magnetic resonance imaging (MRI) from January 2009 to October 2017 were analyzed. In axial sections of cervical spine MRI, three angles to the vertical line (α, angle not to insult carotid sheath; β, angle for the conventional TFESI; γ, angle not to penetrate carotid artery) were measured...
December 2018: Annals of Rehabilitation Medicine
Alp Eren Celenlıoglu, Savas Sencan, Osman Hakan Gunduz
OBJECTIVE: To examine the impact of the presence of facet tropism on the results of transforaminal epidural steroid injection for unilateral radicular pain induced by lumbar disc herniation. MATERIALS AND METHODS: We included 112 patients diagnosed with unilateral, single-level lumbar disc herniation-induced radicular pain. Injection was planned at relevant levels. The patients were assessed using the Numerical Rating Scale, the Modified Oswestry Disability Index, and the Beck Depression Inventory before the injection and at hour 1, week 3, and month 3 after the injection...
January 2, 2019: Skeletal Radiology
Ozsoy-Unubol Tugba, Ercalik Tulay, Gunduz Osman Hakan
OBJECTIVE: Transforaminal epidural steroid injections (TFESIs) have been increasingly used in the treatment of lumbar radicular pain resistant to conservative modalities. While different steroids can be used at different doses, minimal effective steroid doses are recommended to reduce side effects. This study aimed to examine and compare the efficacy of 40mg and 80mg of methylprednisolone in TFESIs. STUDY DESIGN: Retrospective study. METHODS: Sixty-seven patients who had undergone unilateral L5-S1 TFESIs under fluoroscopy included to the study...
December 24, 2018: World Neurosurgery
Alaa-Eldin Adel El Maadawy, Alaa Mazy, Mohamed El Mitwalli Mansour El Adrosy, Ashraf Abdel-Moneim El-Mitwalli, Ayman Mohamed Abd El Naby, Mohammad Gomma
Background: Low back pain (LBP) is one of the most common musculoskeletal abnormalities. Epidural corticosteroid injections (ESIs) have been used long time ago for treatment of lumbar radiculopathy or discogenic back pain in case of failed medical and conservative management. Different techniques for ESIs include the interlaminar, the caudal, and the transforaminal approaches. Purpose: The aim of our study is to compare between the efficacy of infraneural transforaminal ESI and lumbar paramedian nerve root targeted interlaminar steroid injection in reduction of unilateral radicular pain secondary to disc prolapse...
October 2018: Saudi Journal of Anaesthesia
Jung Hwan Lee, Kyoung-Ho Shin, Sung Jin Park, Goo Joo Lee, Chang-Hyung Lee, Dong Hwan Kim, Du Hwan Kim, Hee Seung Yang
BACKGROUND: Epidural injection (EI) is used to treat back or radicular pain from lumbosacral disc herniation (LDH). Although several reports have stated that the transforaminal approach in EI (TFEI) has an advantage in target specificity and yields better clinical efficacy than the interlaminar approach in EI (ILEI), other studies have indicated that the clinical efficacy of ILEI was not inferior to that of TFEI and that ILEI also has the ability to spread medication into the ventral space to a degree similar to that of TFEI...
September 2018: Pain Physician
Serdar Kesikburun, Berke Aras, Bayram Kelle, Ferdi Yavuz, Evren Yaşar, Mehmet A Taşkaynatan
AIM: To investigate the long-term effect of fluoroscopy guided cervical transforaminal epidural steroid injection on neck pain radiating to the arm due to cervical disc herniation. MATERIALS & METHODS: 64 patients (26 women [40.6%], 38 men [59.4%]; mean age, 44.9 ± 12.1 years) who had received fluoroscopy guided cervical transforaminal epidural steroid injection for neck pain due to cervical disc herniation at least 1 year before were included in the study...
September 1, 2018: Pain Management
Semih Gungor, Asli Ozcan
RATIONALE: Perineural cysts, commonly referred to as Tarlov cysts, are cerebrospinal fluid-filled dilations between the perineurium and endoneurium typically arising at the junction of posterior and dorsal root ganglia in the neural foramina. This anatomical location is in close proximity to usual needle trajectory during performing transforaminal epidural injection, and therefore presents a potential risk of dural puncture and associated complications. PATIENT CONCERNS: Severe lower extremity pain interfering with activities of daily living...
September 2018: Medicine (Baltimore)
Martin J Wilby, Carolyn Hopkins, Emma Bedson, Sue Howlin, Girvan Burnside, Elizabeth J Conroy, Dyfrig A Hughes, Manohar Sharma, Anthony Marson, Simon R Clark, Paula Williamson
BACKGROUND: Sciatica is a common condition reported to affect over 3% of the UK population at any time and is often caused by a prolapsed intervertebral disc (PID). Although the duration and severity of symptoms can vary, pain persisting beyond 6 weeks is unlikely to recover spontaneously and may require investigation and treatment. Currently, there is no specific care pathway for sciatica in the National Health Service (NHS), and no direct comparison exists between surgical microdiscectomy and transforaminal epidural steroid injection (TFESI)...
September 5, 2018: Trials
Ramsis F Ghaly, Thomas Zouki, Aby Pynadath, Kenneth D Candido, Nebojsa Nick Knezevic
Background: Chronic low back pain (LBP) is highly prevalent and costly in our society. The use of epidural steroid injections (ESIs) for the treatment of radicular LBP is very widespread and continues to rise. The most popular injection is the lumbar/sacral transforaminal epidural steroid injection (TFESI). Here, we present a serious neurological complication resulting from such a TFESI that was only reversed by timely neurosurgical intervention. Case Description: A 49-year-old male presented with a 5-year history of progressive neurogenic claudication and right lower extremity pain/radiculopathy...
2018: Surgical Neurology International
In Chan Baek, Su Youn Choi, Jiwoo Suh, Shin Hyung Kim
OBJECTIVES: To evaluate the influence of the depth of local anesthesia application on procedural pain during lumbar transforaminal epidural steroid injection (TFESI). DESIGN: Sixty-eight patients were enrolled who were scheduled for single-level, unilateral fluoroscopically-guided lumbar TFESI. Patients were randomly allocated to receive either subcutaneous local anesthesia (group S) or deep local anesthesia (group D) for TFESI. The data related to pain and technical performance during the procedure was compared...
October 5, 2018: American Journal of Physical Medicine & Rehabilitation
Yuanyuan Ding, Hongxi Li, Yongqiang Zhu, Peng Yao, Guangyi Zhao
Background: Lumbar disc herniation (LDH) is a common disease in clinical practice. The symptoms recur and are aggravated by time; severe pain and long-term movement disorder cause physiological and psychological problems that affect the quality of life of patients. Therefore, relieving the pain symptoms and promoting functional recovery are the primary goals that have gained increased attention. Objective: To assess the efficacy of CT-guided transforaminal epidural steroid injection (TFESI) combined with pulsed radio frequency (PRF) on spinal nerve root for the treatment of LDH...
2018: Journal of Pain Research
Kai-Uwe Lewandrowski
OBJECTIVE: To analyze the positive predictive value of diagnostic 1% lidocaine containing transforaminal epidural steroid injections (TESI) for successful outcome after outpatient endoscopic decompression for lumbar foraminal and lateral recess stenosis. PATIENTS AND METHODS: A retrospective study of 1839 consecutive patients with an average mean follow-up of 33 months that underwent endoscopic transforaminal decompression at 2076 lumbar levels was conducted. The sensitivity, specificity, and positive predictive value of lidocaine containing diagnostic TESI at the intended surgical level were calculated based on the recorded frequency of >50% VAS score reduction, intraoperatively visualized stenosis, and clinical outcomes assessed by Macnab criteria and VAS reduction...
October 2018: Clinical Neurology and Neurosurgery
Dong-Yeong Lee, Young-Jin Park, Kun-Tae Kim, Jeong-Hee Lee, Dong-Hee Kim
Epidural steroid injection is one of the most commonly used non-surgical treatments for degenerative lumbar vertebral disease. Its use has increased as degenerative lumbar vertebral disease has increased in frequency. Concomitant complications are being reported more often. In this report, we report a rare case of iatrogenic hemorrhagic cyst following epidural steroid injection. The patient underwent operative treatment with complete resolution of his symptoms.
July 30, 2018: Acta Orthopaedica et Traumatologica Turcica
Aki Fujiwara, Keisuke Watanabe, Keiji Hashizume, Kozue Shinohara, Masahiko Kawaguchi
BACKGROUND: The acute phase of shingles is characterized by severe pain, and one of the complications of shingles known as postherpetic neuralgia (PHN) is associated with prolonged pain. Although factors predicting the development of PHN, as well as its preventative measures, have been investigated, there is no single treatment effective for PHN. Some studies showed effectiveness of epidural injection to alleviate pain associated with acute-phase shingles. In these studies, epidural injection was performed by interlaminar (IL) approach...
July 2018: Pain Physician
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