Abstract
Although possessing a long history of use, the therapeutic use of epidural steroid injections still needs substantiation. Refinements in our understanding of the pathophysiology of radicular pain and in the techniques used to deliver depo-steroids to the target tissue will lead to improved clinical outcomes and fewer technique and drug-related side effects. Administration of epidural steroids at lumbar spine sites is more common than at cervical spine levels, although the same pain management concepts are applicable. Comparative studies are necessary to clearly define the advantages and disadvantages of the use of fluoroscopy and the transforaminal technique.
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References and Recommended Reading
Rowlingson JC: Epidural steroids. Do they have a place in pain management? Am Pain Soc J 1994, 3:20–27.
Saal JS, Franson R, Dobrow R, et al.: High levels of inflammatory phospholipase A2 activity in lumbar disc herniation. Spine 1990, 15:674–678.
Chen C, Cavanaugh JM, Ozaktay AC, et al.: Effects of phospholipase A2 on lumbar nerve root structure and function. Spine 1997, 22:1057–1064.
Hayashi N, Weinstein JN, Meller ST, et al.: The effect of epidural injection of betamethasone or bupivacaine in a rat model of lumbar radiculopathy. Spine 1998, 23:877–885.
Fanciullo GJ, Hanscom B, Seville J, et al.: An observational study of the frequency and pattern of use of epidural steroid injection in 25,479 patients with spinal and radicular pain. Reg Anesth Pain Med 2001, 26:5–11. Patients with radicular/dermatomal pain and associated neurologic signs are often recommended for ESI.
Abram SE: Treatment of lumbosacral radiculopathy with epidural steroids. Anesthesiology 1999, 91:1937–1941.
Ohnmeiss DD, Vanharanta H, Ekholm J: Degree of disc disruption and lower extremity pain. Spine 1997, 22:1600–1605.
Fukusaki M, Kobayashi I, Hara T, Sumikawa K: Symptoms of spinal stenosis do not improve after epidural steroid injection. Clin J Pain 1998, 14:148–151.
Koes BW, Scholten R, Mens JMA, Barter LM: Epidural steroid injections for low back pain and sciatica: an updated systematic review of randomized clinical trials. Pain Digest 1999, 9:241–247. An evidence-based medicine approach to clinical trials of ESIs still cannot conclusively document their benefit.
Buchner M, Zeifang F, Brocai DRC, Schiltenwolf M: Epidural corticosteroid injection in the conservative management of sciatica. Clin Orthop 2000, 375:149–156.
McQuay HJ, Moore RA: An Evidence-Based Resource for Pain Relief. Oxford, UK: Oxford University Press; 1998.
Rowlingson JC, Kirschenbaum LP: Epidural analgesic techniques in the management of cervical pain. Anesth Analg 1986, 65:938–942.
Klein GR, Vaccaro AR, Cwik J, et al.: Efficacy of cervical epidural steroids in the treatment of cervical spine disorders. Am J Anesthesiol 2000, 9:547–550.
Hopwood MB, Manning DC: Lumbar epidural steroid injections: is a clinical trial necessary or appropriate? Reg Anesth Pain Med 1999, 24:5–7.
Slipman CW, Lipetz JS, Jackson HB, et al.: Therapeutic selective nerve root block in the nonsurgical treatment of atraumatic cervical spondylotic radicular pain: a retrospective analysis with independent clinical review. Arch Phys Med Rehabil 2000, 81:741–746.
Bush K, Chaudhuri R, Hillier S, Penny J: The pathomorphological changes that accompany the resolution of cervical radiculopathy: a prospective study with repeat magnetic resonance imaging. Spine 1997, 22:183–187.
Hodges SD, Castleberg RL, Miller T, et al.: Cervical epidural steroid injection with intrinsic spinal cord damage: two case reports. Spine 1998, 23:2137–2142.
Weiner BK, Fraser RD: Foraminal injection for lateral lumbar disc herniation. J Bone Joint Surg Br 1997, 79B:804–807.
Devulder J: Transforaminal nerve root sleeve injection with corticosteroids, hyaluronidase, and local anesthetic in the failed back surgery syndrome. J Spinal Disord 1998, 11:151–154.
Lutz GE, Vad VB, Wisneski RJ: Fluoroscopic transforaminal lumbar epidural steroids: an outcome study. Arch Phys Med Rehabil 1998, 79:1362–1366. Fluoroscopic transforaminal ESIs are an effective nonsurgical treatment for patients with radiculopathy.
Botwin KP, Gruber RD, Bouchlas CG, et al.: Complications of fluoroscopically guided transforaminal lumbar epidural injections. Arch Phys Med Rehabil 2000, 81:1045–1050.
Liu SS, Melmed AP, Klos JW, Innis CA: Prospective experience with a 20-guage Tuohy needle for lumbar epidural steroid injections: is confirmation with fluoroscopy necessary? Reg Anesth Pain Med 2001, 26:143–146.
Fredman B, Nun MB, Zohar E, et al.: Epidural steroids for treating “failed back surgery syndrome”: is fluoroscopy really necessary? Anesth Analg 1999, 88:367–372.
Rowlingson JC: Epidural steroids in treating failed back surgery syndrome. Anesth Analg 1999, 88:240–242.
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Mulligan, K.A., Rowlingson, J.C. Epidural steroids. Current Science Inc 5, 495–502 (2001). https://doi.org/10.1007/s11916-001-0066-2
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DOI: https://doi.org/10.1007/s11916-001-0066-2