Treatment of backache with spinal injections of local anesthetics, spinal and systemic steroids. A review

Kepes, Edith R.; Duncalf, Deryck

doi:10.1016/0304-3959(85)90146-0

Cited by 111 publications

(45 citation statements)

References 62 publications

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“…However, while interlaminar injection in acute LDH has shown a strong QALY benefit of $2050, the optimal patient profile for maximum benefit remains unknown [49•]. Historical success rates of these injections in acute LDH are 20-95% [50] and are thought to be due to reduction in local inflammatory cytokine concentration. When compared to placebo injections, historical data suggests CSI offer short-term improvements in leg pain and sensory deficits but may not reduce the rate of surgical intervention or provide substantial functional benefit [51].…”

Section: Treatment Non-operativementioning

confidence: 99%

Lumbar Disc Herniation

Amin

Andrade

Neuman³

2017

Curr Rev Musculoskelet Med

243

202

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Purpose of Review Substantial advancements have been made in the cause, diagnosis, imaging, and treatment options available for patients with lumbar disc herniation (LDH). We examined the current evidence and highlight the concepts on the frontline of discovery in LDH. Recent Findings There are a myriad of novel etiologies of LDH detailed in recent literature including inflammatory factors and infectious microbes. In the clinical setting, recent data focuses on improvements in computer tomography as a diagnostic tool and non-traditional injection options including tumor necrosis alpha inhibitors and platelet-rich plasma. Operative treatment outcomes have focused on minimally invasive endoscopic approaches and demonstrated robust 5-year post-operative outcomes. Summary Advances in the molecular etiology of LDH will continue to drive novel treatment options. The role of endoscopic treatment for LDH will continue to evolve. Further research into10-year outcomes will be necessary as this surgical approach continues to gain widespread popularity.

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Section: Treatment Non-operativementioning

confidence: 99%

Lumbar Disc Herniation

Amin

Andrade

Neuman³

2017

Curr Rev Musculoskelet Med

243

202

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“…It has also been included as an often-used orthodox therapy in an orthopaedic text of the gold standard class 9 . The most dreaded complication was epidural abscess 5,11,21 and localized infection of various forms 31,37 , whereas complications such as meningitis 3,40 and arachnoiditis 27,34,45 occurred rarely 4,13,48 and only in subdural injections 28,30,39 or not at all 12,17,38 . Other rare forms such as retinal haemorrhage, myopathy and lipomatosis associated with Cushing's syndrome have also been reported.…”

Section: Introductionmentioning

confidence: 99%

Epidural Steroid Injection for Sciatica: An Analysis of 526 Consecutive Cases with Measurements and the Whistle Test

Loy

2000

J Orthop Surg (Hong Kong)

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The effects of epidural injections of triamcinolone acetonide and bupivacaine in the treatment of sciatica were analyzed in a retrospective series of 526 consecutive cases with measurements. A new test (the whistle test) is described. There is a paucity of measureable parameters in reports on the subject in the literature, and many are not specific or symptomoriented to sciatica. The procedure was performed by the same operator and reviewed one week postoperatively with measurements. 491 patients (93.35%) achieved excellent to good pain relief, backed by appropriate increases of straight-leg-raise measurements. But 17 patients (3.46%) of this group required surgery later. It is concluded that epidural steroid injection is a simple, cost-effective and minimally invasive treatment for sciatica, especially in the acute. It also serves as a method for crisis intervention and as a prognosticator.

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“…NEUROLOGY 2007;68:723-729 Chronic back pain and its associated disabilities represent an important health problem. 1 The rising prevalence of obesity may increase the impact of chronic back pain. The competitive nature of the modern workplace places individuals with less than perfect health and, in particular, those with painful conditions at a disadvantage.…”

mentioning

confidence: 99%

Assessment: Use of epidural steroid injections to treat radicular lumbosacral pain

Armon¹,

Argoff²,

Samuels³

et al. 2007

Neurology

193

140

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Abstract-Based on the available evidence, the Therapeutics and Technology Assessment subcommittee concluded that 1) epidural steroid injections may result in some improvement in radicular lumbosacral pain when assessed between 2 and 6 weeks following the injection, compared to control treatments (Level C, Class I-III evidence). The average magnitude of effect is small and generalizability of the observation is limited by the small number of studies, highly selected patient populations, few techniques and doses, and variable comparison treatments; 2) in general, epidural steroid injection for radicular lumbosacral pain does not impact average impairment of function, need for surgery, or provide long-term pain relief beyond 3 months. Their routine use for these indications is not recommended (Level B, Class I-III evidence); 3) there is insufficient evidence to make any recommendation for the use of epidural steroid injections to treat radicular cervical pain (Level U). NEUROLOGY 2007;68:723-729 Chronic back pain and its associated disabilities represent an important health problem. 1 The rising prevalence of obesity may increase the impact of chronic back pain. The competitive nature of the modern workplace places individuals with less than perfect health and, in particular, those with painful conditions at a disadvantage. Workplace accommodation may not be an option for many occupations and, even where possible, is frequently linked with economic losses for employee and employer alike.In 1998, individuals with back pain in the United States were estimated to have incurred total health care expenditures of $90.7 billion.2 Inpatient care accounted for 31% of the expenditure, followed by expenditure for office-based visits (26%), prescription drugs (15.6%), and outpatient services (13.1%). Emergency department visits and home health visits each accounted for 3%. Of the $90.7 billion total expenditures incurred by these individuals, the expenditures attributable directly to the back pain totaled approximately $26.3 billion, 2 of which 42% were for office-based visits, 18% for outpatient services, 17% for inpatient care, 15% for prescription drugs, and 4% for emergency room visits. The estimated cost of treatments for spinal pain (medical therapy, epidural steroid injections, spinal cord stimulation, and intrathecal narcotics) for 1990 was at least $13 billion, growing by 7% per year.3 Medicare part B claims in 1999 for 40.4 million covered individuals were $49.9 million for lumbar epidural steroid injections, $8.5 million for lumbar facet or peri-facet joint injections, and $5.6 million for cervical or thoracic epidural steroid injections. 4 Low back pain may occur without or with radicular features (the latter often referred to as sciatica). In the strictest sense, sciatica refers to pain running down the posterior aspect of the lower extremity. A less restrictive usage to refer to lower back pain with

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Treatment of backache with spinal injections of local anesthetics, spinal and systemic steroids. A review

Cited by 111 publications

References 62 publications

Lumbar Disc Herniation

Lumbar Disc Herniation

Epidural Steroid Injection for Sciatica: An Analysis of 526 Consecutive Cases with Measurements and the Whistle Test

Assessment: Use of epidural steroid injections to treat radicular lumbosacral pain

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