Therapeutic Trial of Fluoroscopic Interlaminar Epidural Steroid Injection for Axial Low Back Pain: Effectiveness and Outcome Predictors

Lee, J.W.; Shin, Hyung Ik; Park, S.Y.; Lee, G.Y.; Kang, Han Sug

doi:10.3174/ajnr.a2180

Cited by 27 publications

(20 citation statements)

References 21 publications

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“…Although there is no high-quality ESI trial focused on degenerative neural foraminal stenosis alone, a small group of studies showed the effectiveness of transforaminal injection in patients with neural foraminal stenosis (37). For patients with axial low back pain, Lee et al (38) proposed a therapeutic trial of interlaminar ESI before discography when discogenic back pain is suspected.…”

Section: Indications Choice Of Approach and Contraindicationsmentioning

confidence: 99%

Fluoroscopically Guided Epidural Injections of the Cervical and Lumbar Spine

Shim

Lee

et al. 2017

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Advances in imaging and the development of injection techniques have enabled spinal intervention to become an important tool in managing chronic spinal pain. Epidural steroid injection (ESI) is one of the most widely used spinal interventions; it directly delivers drugs into the epidural space to relieve pain originating from degenerative spine disorders-central canal stenoses and neural foraminal stenoses-or disk herniations. Knowledge of the normal anatomy of the epidural space is essential to perform an effective and safe ESI and to recognize possible complications. Although computed tomographic (CT) or combined CT-fluoroscopic guidance has been increasingly used in ESI, conventional fluoroscopic guidance is generally performed. In ESI, drugs are delivered into the epidural space by interlaminar or transforaminal routes in the cervical spine or by interlaminar, transforaminal, or caudal routes in the lumbar spine. Epidurography is usually performed before drug delivery to verify the proper position of the needle in the epidural space. A small amount of contrast agent is injected with fluoroscopic guidance. Familiarity with the findings on a typical "true" epidurogram (demonstrating correct needle placement in the epidural space) permits proper performance of ESI. Findings on "false" epidurograms (demonstrating incorrect needle placement) include muscular staining and evidence of intravascular injection, inadvertent facet joint injection, dural puncture, subdural injection, and intraneural or intradiscal injection. RSNA, 2016 An earlier incorrect version of this article appeared online. This article was corrected on December 22, 2016.

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Section: Indications Choice Of Approach and Contraindicationsmentioning

confidence: 99%

Fluoroscopically Guided Epidural Injections of the Cervical and Lumbar Spine

Shim

Lee

et al. 2017

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“…This assessment has been used previously by multiple authors. 18,19 There were some limitations in this study. Only a preinjection epidurography was noted, the post injection film could have shown improvement in contrast dispersion following the drug injection.…”

Section: Resultsmentioning

confidence: 90%

Clinical Outcome and Flouroscopic Comparison of Two Different Approaches of Epidural Steroid in Low Backache Patients

Sandhu¹,

Gupta²,

Singh³

et al. 2014

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Epidural steroid injections have a long history of efficacy and safety in treating low back pain and radiculitis still their use remains controversial. OBJECTIVES: To compare and correlate clinical outcome with flouroscopic findings of interlaminar midline with caudal approaches for epidural steroid injections in low backache patients. METHODS: In a randomised manner, 40 patients with chronic low backache with or without leg radiation, either received midline interlaminar (Group A; n=20) or caudal epidural block (Group B; n=20) under fluoroscopic guidance and epidurography was noted. A two weekly follow up till 3 month done, recording VAS (Visual Analogue Scale) and Modified NASS patient satisfaction index score (NASSPSI). RESULTS: Demographic and preinjection clinical data was comparable between groups (p>0.05). Improvement in VAS score was seen in both groups compared to baseline (p<0.001); comparable amongst groups (p>0.05). Dorsal spread was seen in all patients, ventral spread was seen in 30% patients in group A and 20% patients in group B. Nerve root spread was seen in 70% patients in Group A and 60% patients in Group B. All findings were statistically comparable between groups. Clinical outcome in terms of percentage improvement in VAS at 3 months did not correlate with ventral spread (p< 0.05). Nor did it correlate with nerve root spread (p>0.05). More than 70% patients in both groups were satisfied (NASSPSI 1 & 2) with their results on last follow up. CONCLUSION: Presence of ventral spread of contrast did not correlate well with VAS improvement. Both approaches were comparable for improving pain and providing patient satisfaction.

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“…An intra-articular facet joint steroid injection was considered for patients presenting with the following: 1) severe low back pain [verbal numeric rating score (0-10) > 5.0]; 2) low back pain that was aggravated by position change including forward flexion and extension rotation; 3) focal tenderness in the paravertebral area in the lower lumbar level; and 4) low back pain without response after more than one month of conservative treatment, such as medication and physical therapy or persistent low back pain after a previous epidural steroid injection (21). year in our department (22,23).…”

Section: Patient Selectionmentioning

confidence: 99%

Fluoroscopy-Guided Intra-Articular Facet Joint Steroid Injection for the Management of Low Back Pain: Therapeutic Effectiveness and Arthrographic Pattern

Kim

Lee

Chai

et al. 2015

J Korean Soc Radiol

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Purpose:To evaluate the effectiveness of fluoroscopy-guided intra-articular facet joint steroid injection for the management of low back pain, and to document the incidence of epidural leakage. Materials and Methods: In total, 320 facet joint injections of 244 consecutive patients were included in this study. All patients had undergone an intra-articular facet joint steroid injection in 2007 and had follow-up post-treatment medical records. The response to treatment was analyzed on the basis of chart documentation (aggravated, no change, slightly improved, much improved, no pain). Fluoroscopic arthrograms of the injections were retrospectively analyzed by two radiologists. Results: Of the 244 patients, 85.2% (n = 208) showed improvement after an initial intra-articular facet joint steroid injection. A total of 77.9% (n = 162) of the patients showed symptom recurrence, with a median of a 69 day symptom-free interval, while 30.3% (n = 74) of the patients showed symptom-free intervals of more than six months. Overall, 74 (33.3%) of the 222 cases of intra-articular facet joint steroid injections without concomitant epidural steroid injection showed epidural leakage in fluoroscopic arthrograms. Conclusion: Fluoroscopy-guided intra-articular facet joint injection is a reliable technique for the management of low back pain, with excellent immediate effectiveness and good prolonged (> 2 months) pain relief. Epidural leakage during injection was detected in one-third of the cases.

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Therapeutic Trial of Fluoroscopic Interlaminar Epidural Steroid Injection for Axial Low Back Pain: Effectiveness and Outcome Predictors

Abstract: BACKGROUND AND PURPOSE:An ESI for managing LBP is one of the most commonly performed interventions. The purpose of this observational study was to assess the effect of a therapeutic trial of a fluoroscopic interlaminar ESI for axial LBP and to analyze the outcome predictors.

Cited by 27 publications

References 21 publications

Fluoroscopically Guided Epidural Injections of the Cervical and Lumbar Spine

Fluoroscopically Guided Epidural Injections of the Cervical and Lumbar Spine

Clinical Outcome and Flouroscopic Comparison of Two Different Approaches of Epidural Steroid in Low Backache Patients

Fluoroscopy-Guided Intra-Articular Facet Joint Steroid Injection for the Management of Low Back Pain: Therapeutic Effectiveness and Arthrographic Pattern

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