Lumbar Epidural Steroid Injections

Friedrich, Jason; Harrast, Mark A.

doi:10.1249/jsr.0b013e3181caa7fc

Cited by 25 publications

(5 citation statements)

References 24 publications

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“…umbosacral epidural injections are considered for varying spinal disorders. [1][2][3][4][5][6][7] The utility of transforaminal and interlaminar lumbosacral epidural injections has been well-established for radicular pain due to lumbar disk herniations. [2][3][4][5] In contrast, current literature is mixed for the efficacy of lumbar epidural injections for radicular pain due to lumbar spinal stenosis.…”

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confidence: 99%

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Changes in the Utilization of Lumbosacral Epidural Injections Between 2010 and 2019

Ratnasamy

Gouzoulis

Kammien

et al. 2022

Spine

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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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mentioning

confidence: 99%

“…Lumbosacral epidural injections are considered for varying spinal disorders 1–7. The utility of transforaminal and interlaminar lumbosacral epidural injections has been well-established for radicular pain due to lumbar disk herniations 2–5.…”

mentioning

confidence: 99%

Changes in the Utilization of Lumbosacral Epidural Injections Between 2010 and 2019

Ratnasamy

Gouzoulis

Kammien

et al. 2022

Spine

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“…Triamcinolone is a particulate steroid that theoretically might cause complications, such as vascular penetration, dizziness, nausea, an increase of blood sugar or tension, arrythmia, or even paraplegia due to nerve damage. However, it did not happen among them [ 21 , 22 ]. There is no correlation between the amount of drug dose and the intraepidural therapeutic effect of steroids for reducing pain or neurological improvement.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Discectomy Followed by CESI Might Improve Neurological Disorder of Drop Foot Patients Due to Chronic LDH

Budisulistyo

Atmaja²

2020

Brain Sciences

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(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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“…The indications for TFESI include lumbosacral radiculopathy and spinal stenosis 7 . Contraindications include anticoagulants and coagulation defects because of the risk of epidural hematoma, along with spinal cord compression 8,9 .…”

Section: Interventional Pain Proceduresmentioning

confidence: 99%

Nonsurgical Interventional Spine Pain Procedures

et al. 2023

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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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Lumbar Epidural Steroid Injections

Cited by 25 publications

References 24 publications

Changes in the Utilization of Lumbosacral Epidural Injections Between 2010 and 2019

Changes in the Utilization of Lumbosacral Epidural Injections Between 2010 and 2019

Percutaneous Discectomy Followed by CESI Might Improve Neurological Disorder of Drop Foot Patients Due to Chronic LDH

Nonsurgical Interventional Spine Pain Procedures

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