Conclusion
Selective nerve root and epidural steroid injections are safe outpatient procedures, best performed by using image guidance in conjunction with contrast agents. Use of the techniques described in this chapter will minimize rates of both minor and serious complication. The author has performed several thousand procedures in an outpatient setting without any serious complications.37 Optimal safety and efficacy require an excellent working knowledge of the radiographic anatomy and the imaging equipment used to perform these procedures. Several studies have demonstrated the difficulty and uncertainty of obtaining an accurate injection without imaging guidance. Radiologists who are well trained in the performance of image-guided percutaneous injection procedures are thus best qualified to perform these procedures in a safe and efficacious manner. When properly performed, these procedures have a clinically established role in the management of neck and back pain.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Evans W. Intrasacral epidural injection therapy in the treatment of sciatica. Lancet 2:1225, 1930.
Cathelin MF. Une nouvelle voie d’injection rachidienne. Méthode des injections epidurales par le procedure du canal sacre. C R Soc Biol Paris 53:452, 1901.
Pages E. Anestesia metamerica. Rev Sanid Mil Madrid 11:351, 1921.
Groen GJ, Balijet B, Drukker J. Nerves and nerve plexuses of the human vertebral column. Am J Anat 163:282, 1990.
Husemeyer RP, White DC. Topography of the lumbar epidural space. A study in cadavers using injected polyester resin. Anaesthesia 35:7, 1980.
Saal JS, Franson RC, Dobrow R, et al. High levels of inflammatory phos-pholipase A2 activity in lumbar disc herniations. Spine 15:674, 1990.
Rutkowski MD, Winkelstein BA, Hickey WF, et al. Lumbar nerve root injury induces central nervous system neuroimmune activation and neuroinflammation in the rat. Spine 27:1604, 2002.
Benzon HT. Epidural steroid injections for low back pain and lumbosacral radiculopathy. Pain 24:277, 1986.
Johansson A, Hao J, Sjolund B. Local corticosteroid application blocks transmission in normal nociceptive C-fibres. Acta Anaesthesiol Scand 34:335, 1990.
Winnie AP, Hartman JT, Meyers HI, et al. Pain Clinic II: Intradural and extradural corticosteroids for sciatica. Anesth Analg 51:990, 1972.
Greenwood JJ, McGuire TA, Kimbell F. A study of the cause of failure in the herniated intervertebral disc operation. J Neurosurg 9:15, 1952.
Berman AT, Garbarino JL, Fisher SM, et al. The effects of epidural steroid injection of local anesthetics and corticosteroids on patients with lumbosciatic pain. Clin Orthop 188:144, 1984.
Bowman SJ, Wedderburn L, Whaley A, et al. Outcome assessment after epidural corticosteroid injection for low back pain and sciatica. Spine 18:1345, 1993.
Burn JMB, Langdon L. Lumbar epidural injection for the treatment of chronic sciatica. Rheum Phys Med 10:368, 1970.
Bush K, Hillier S. A controlled study of caudal epidural injection of triamcinolone plus procaine for the management of intractable sciatica. Spine 16:572, 1991.
Coomes EN. A comparison between epidural anaesthesia and bed rest in sciatica. Br Med J 1:20, 1961.
Dilke TFW, Burry HC, Grahame R. Extradural corticosteroid injection in management of lumbar nerve root compression. Br Med J 2:635, 1973.
Goldie I, Peterhoff V. Epidural anaesthesia in low back pain and sciatica. Acta Orthop Scand 39:261, 1968.
Heyse-Moore GH. A rational approach to the use of epidural medication in the treatment of sciatic pain. Acta Orthop Scand 49:366, 1978.
Rivest C, Katz JN, Ferrante FM, et al. Effects of epidural steroid injection on pain due to lumbar spinal stenosis or herniated disks: a prospective study. Arthritis Care Res 11:291, 1998.
Yates DW. A comparison of the types of epidural injection commonly used in the treatment of low back pain and sciatica. Rheumatol Rehabil 17:181, 1978.
Karppinen J, Malmivaara A, Kurunlahti M, et al. Periradicular infiltration for sciatica: a randomized controlled trial. Spine 26:1059, 2001.
North RB, Kidd DH, Zahurak M, et al. Specificity of diagnostic nerve blocks: a prospective, randomized study of sciatica due to lumbosacral spine disease. Pain 65:77, 1996.
Pfirrmann CW, Oberholzer PA, Zanetti M, et al. Selective nerve root blocks for the treatment of sciatica: evaluation of injection site and effectivenessa study with patients and cadavers. Radiology 221:704, 2001.
Riew KD, Yin Y, Gilula L, et al. The effect of nerve-root injections on the need for operative treatment of lumbar radicular pain. A prospective, randomized, controlled, double-blind study. J Bone Joint Surg 82:1589, 2000.
Viton JM, Peretti-Viton P, Rubino T, et al. Short-term assessment of periradicular corticosteroid injections in lumbar radiculopathy associated with disc pathology. Neuroradiology 40:59, 1998.
Weiner BK, Fraser RD. Foraminal injection for lateral lumbar disc herniation. J Bone Joint Surg (Br) 79:804, 1997.
Ridley MG, Kingsley GH, Gibson T, et al. Outpatient lumbar epidural corticosteroid injection in the management of sciatica. Br J Rheumatol 27:295, 1988.
Johnson BA, Schellhas KP, Pollei SR, Kraker D. Lumbar epidural myelography and steroid injections: correlation of clinical efficacy related to specific pathology and symptoms. Presented at Fifth Annual Meeting of the International Spinal Injection Society, October 4–5, 1997, Denver.
Renfrew DL, Moore TE, Kathol MH, et al. Correct placement of epidural steroid injections: fluoroscopic guidance and contrast administration. AJNR Am J Neuroradiol 12:1003, 1991.
White AH, Derby R, Wynne G. Epidural injections for the diagnosis and treatment of low-back pain. Spine 5:78, 1980.
MacLean CA, Bachman DT. Documented arterial gas embolism after spinal epidural injection. Ann Emerg Med 38:592, 2001.
Johnson BA. Image guided epidural injections. Neuroimaging Clin North Am 10(3):479, 2000.
Fukushige T, Kano T, Sano T. Radiographic investigation of unilateral epidural block after single injection. Anesthesiology 87:1574, 1997.
Botwin KP, Gruber RD, Bouchlas CG, et al. Complications of fluoroscopically guided transforaminal lumbar epidural injections. Arch Phys Med Rehabil 81:1045, 2000.
Slipman CW, Shin CH, Patel RK, et al. Persistent hiccup associated with thoracic epidural injection. Am J Phys Med Rehabil 80:618, 2001.
Johnson BA, Schellhas KP, Pollei SR. Epidurography and therapeutic epidural injections: Technical considerations and experience with 5334 cases. AJNR Am J Neuroradiol 20:697, 1999.
Quencer RM, Tenner M, Rothman L. The postoperative myelograms. Radiology 123;667, 1977.
Gibran S, Mirza K, Kinsella F. Unilateral vitreous haemorrhage secondary to caudal epidural injection: a variant of Terson’s syndrome. Br J Ophthalmol 86:353, 2002.
Naseri A, Blumenkranz MS, Horton JC. Terson’s syndrome following epidural saline injection. Neurology 57:364, 2001.
McLain RF, Fry M, Hecht ST. Case report: transient paralysis associated with epidural steroid injection. J Spinal Disord 10:441, 1997.
Klenerman L, Greenwood R, Davenport HT, et al. Lumbar epidural injections in the treatment of sciatica. Br J Rheumatol 23:35, 1984.
Mathews JA, Mills SB, Jenkins VM, et al. Back pain sciatica: controlled trials of manipulation, traction, sclerosant and epidural injections. Br J Rheumatol 26:416, 1987.
Field J, Rathmell JP, Stephenson JH. Neuropathic pain following cervical epidural steroid injection. Anesthesiology 93:885, 2000.
Siegfried RN. Development of complex regional pain syndrome after a cervical epidural steroid injection. Anesthesiology 86:1394, 1997.
Hodges SD, Castleberg RL, Miller T, et al. Cervical epidural steroid injection with intrinsic spinal cord damage. Spine 23:137, 1998.
Brouwers PJ, Kottink EJ, Simon MA, et al. A cervical anterior spinal artery syndrome after diagnostic blockade of the right C6-nerve root. Pain 91:397, 2001.
Furman MB, O’Brien EM, Zgleszewski TM. Incidence of intravascular penetration in transforaminal lumbosacral epidural steroid injections. Spine 25:2628, 2000.
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2004 Springer-Verlag New York, Inc.
About this chapter
Cite this chapter
Johnson, B.A. (2004). Epidural Steroid Injections and Selective Nerve Blocks. In: Johnson, B.A., Staats, P.S., Wetzel, F.T., Mathis, J.M. (eds) Image-Guided Spine Interventions. Springer, New York, NY. https://doi.org/10.1007/0-387-21794-0_9
Download citation
DOI: https://doi.org/10.1007/0-387-21794-0_9
Publisher Name: Springer, New York, NY
Print ISBN: 978-0-387-40320-5
Online ISBN: 978-0-387-21794-9
eBook Packages: Springer Book Archive