Download PDF
Semin intervent Radiol 2018; 35(04): 290-298
DOI: 10.1055/s-0038-1673421
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Steroids Spinal Injections

Stefano Marcia
1   Chief of Diagnostic and Interventional Radiology, Ospedale “Santissima Trinità”, Cagliari, Italy
,
Chiara Zini
2   Department of Radiology, Ospedale “Santa Maria Annunziata”, Azienda Ospedaliera Toscana Centro, Firenze, Italy
,
Joshua A. Hirsch
3   Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
,
Ronil V. Chandra
4   Diagnostic and Interventional Neuroradiology, Monash Imaging, Monash Health, Melbourne, Australia
5   Chief of Stroke Imaging and Endovascular Clot Retrieval, Monash Imaging, Monash Health, Melbourne, Australia
6   Neurovascular Surgery, Monash Health, Melbourne, Australia
7   Chief of Neurovascular Imaging Research, Monash Health, Melbourne, Australia
8   Departments of Surgery and Medicine, Monash Health, Melbourne, Australia
,
Matteo Bellini
9   Chief of Minimal Invasive Spinal Treatment Unit
10   Neuroimaging and Neurointerventional Unit
11   Department of Neurological and Neurosensorial Sciences
12   Ospedale “Santa Maria alle Scotte”, Azienda Ospedaliera Universitaria Senese, Siena, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
05 November 2018 (online)

Also available at
    Permissions and Reprints

Abstract

Spinal pain is a common condition leading to significant disability and high cost. Spinal injections have been demonstrated to be effective short-term treatments with cost–utility superior to numerous other treatments, including surgical procedures. Appropriate patient selection—based on clinical and imaging finding—and the use of image guidance associated with technical precautions improve the safety and effectiveness of spinal injection and overall patient outcomes.

Keywords

spinal injection - epidural infiltration - foraminal infiltration - back pain - interventional radiology
 

  • References

  • 1 Abdi S, Datta S, Trescot AM. , et al. Epidural steroids in the management of chronic spinal pain: a systematic review. Pain Physician 2007; 10 (01) 185-212
    PubMedGoogle Scholar
  • 2 Murray CJ, Atkinson C, Bhalla K. , et al; U.S. Burden of Disease Collaborators. The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. JAMA 2013; 310 (06) 591-608
    CrossrefPubMedGoogle Scholar
  • 3 Hoy D, March L, Brooks P. , et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis 2014; 73 (06) 968-974
    Google Scholar
  • 4 Hoy D, March L, Woolf A. , et al. The global burden of neck pain: estimates from the global burden of disease 2010 study. Ann Rheum Dis 2014; 73 (07) 1309-1315
    CrossrefPubMedGoogle Scholar
  • 5 Gaskin DJ, Richard P. The economic costs of pain in the United States. J Pain 2012; 13 (08) 715-724
    CrossrefPubMedGoogle Scholar
  • 6 Kaye AD, Manchikanti L, Abdi S. , et al. Efficacy of epidural injections in managing chronic spinal pain: a best evidence synthesis. Pain Physician 2015; 18 (06) E939-E1004
    PubMedGoogle Scholar
  • 7 Manchikanti L, Buenaventura RM, Manchikanti KN. , et al. Effectiveness of therapeutic lumbar transforaminal epidural steroid injections in managing lumbar spinal pain. Pain Physician 2012; 15 (03) E199-E245
    CrossrefPubMedGoogle Scholar
  • 8 Cavanaugh JM, Ozaktay AC, Yamashita HT, King AI. Lumbar facet pain: biomechanics, neuroanatomy and neurophysiology. J Biomech 1996; 29 (09) 1117-1129
    CrossrefPubMedGoogle Scholar
  • 9 Saal JS, Franson RC, Dobrow R, Saal JA, White AH, Goldthwaite N. High levels of inflammatory phospholipase A2 activity in lumbar disc herniations. Spine 1990; 15 (07) 674-678
    CrossrefPubMedGoogle Scholar
  • 10 Olmarker K, Blomquist J, Strömberg J, Nannmark U, Thomsen P, Rydevik B. Inflammatogenic properties of nucleus pulposus. Spine 1995; 20 (06) 665-669
    CrossrefPubMedGoogle Scholar
  • 11 Dunlop RB, Adams MA, Hutton WC. Disc space narrowing and the lumbar facet joints. J Bone Joint Surg Br 1984; 66 (05) 706-710
    PubMedGoogle Scholar
  • 12 Murtagh FR, Paulsen RD, Rechtine GR. The role and incidence of facet tropism in lumbar spine degenerative disc disease. J Spinal Disord 1991; 4 (01) 86-89
    PubMedGoogle Scholar
  • 13 Farfan HF, Huberdeau RM, Dubow HI. Lumbar intervertebral disc degeneration: the influence of geometrical features on the pattern of disc degeneration--a post mortem study. J Bone Joint Surg Am 1972; 54 (03) 492-510
    CrossrefPubMedGoogle Scholar
  • 14 Palmer WE. Spinal injections for pain management. Radiology 2016; 281 (03) 669-688
    CrossrefPubMedGoogle Scholar
  • 15 Lee HM, Weinstein JN, Meller ST, Hayashi N, Spratt KF, Gebhart GF. The role of steroids and their effects on phospholipase A2. An animal model of radiculopathy. Spine 1998; 23 (11) 1191-1196
    CrossrefPubMedGoogle Scholar
  • 16 Derby R, Lee SH, Date ES, Lee JH, Lee CH. Size and aggregation of corticosteroids used for epidural injections. Pain Med 2008; 9 (02) 227-234
    CrossrefPubMedGoogle Scholar
  • 17 Scanlon GC, Moeller-Bertram T, Romanowsky SM, Wallace MS. Cervical transforaminal epidural steroid injections: more dangerous than we think?. Spine 2007; 32 (11) 1249-1256
    CrossrefPubMedGoogle Scholar
  • 18 Okubadejo GO, Talcott MR, Schmidt RE. , et al. Perils of intravascular methylprednisolone injection into the vertebral artery. An animal study. J Bone Joint Surg Am 2008; 90 (09) 1932-1938
    Google Scholar
  • 19 U.S. Food and Drug Administration. Drug Safety Communications. FDA Drug Safety Communication: FDA requires label changes to warn of rare but serious neurologic problems after epidural corticosteroid injections for pain. Available: http://www.fda.gov/downloads/Drugs/DrugSafety/UCM394286.pdf . Accessed September 15, 2018
    PubMedGoogle Scholar
  • 20 American Society of Anesthesiologists. ASA Formally Responding to FDA Warning on Injection of Corticosteroids into Epidural Space. Available: https://www.asahq.org/advocacy/fda-and-washington-alerts/washington-alerts/2014/07/asa-formally-responding-to-fda-warning-on-injection-of-corticosteroids-into-epiduralspace?page=5 . Accessed September 15, 2018
    PubMedGoogle Scholar
  • 21 Rathmell JP, Benzon HT, Dreyfuss P. , et al. Safeguards to prevent neurologic complications after epidural steroid injections: consensus opinions from a multidisciplinary working group and national organizations. Anesthesiology 2015; 122 (05) 974-984
    CrossrefPubMedGoogle Scholar
  • 22 Racoosin JA, Seymour SM, Cascio L, Gill R. Serious neurologic events after epidural glucocorticoid injection--the FDA's risk assessment. N Engl J Med 2015; 373 (24) 2299-2301
    CrossrefPubMedGoogle Scholar
  • 23 Buy X, Gangi A. Percutaneous treatment of intervertebral disc herniation. Semin Intervent Radiol 2010; 27 (02) 148-159
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Lilius G, Laasonen EM, Myllynen P, Harilainen A, Grönlund G. Lumbar facet joint syndrome. A randomised clinical trial. J Bone Joint Surg Br 1989; 71 (04) 681-684
    PubMedGoogle Scholar
  • 25 Bogduk N. International Spinal Injection Society guidelines for the performance of spinal injection procedures. Part 1: Zygapophysial joint blocks. Clin J Pain 1997; 13 (04) 285-302
    CrossrefPubMedGoogle Scholar
  • 26 Kelekis AD, Filippiadis DK, Martin JB, Brountzos E. Standards of practice: quality assurance guidelines for percutaneous treatments of intervertebral discs. Cardiovasc Intervent Radiol 2010; 33 (05) 909-913
    CrossrefPubMedGoogle Scholar
  • 27 Renfrew DL, Moore TE, Kathol MH, el-Khoury GY, Lemke JH, Walker CW. Correct placement of epidural steroid injections: fluoroscopic guidance and contrast administration. AJNR Am J Neuroradiol 1991; 12 (05) 1003-1007
    PubMedGoogle Scholar
  • 28 Deli M, Fritz J, Mateiescu S. , et al. Saline as the sole contrast agent for successful MRI-guided epidural injections. Cardiovasc Intervent Radiol 2013; 36 (03) 748-755
    CrossrefPubMedGoogle Scholar
  • 29 Provenzano DA, Narouze S. Sonographically guided lumbar spine procedures. J Ultrasound Med 2013; 32 (07) 1109-1116
    CrossrefPubMedGoogle Scholar
  • 30 Shim E, Lee JW, Lee E, Ahn JM, Kang Y, Kang HS. Fluoroscopically guided epidural injections of the cervical and lumbar spine. Radiographics 2017; 37 (02) 537-561
    CrossrefPubMedGoogle Scholar
  • 31 Manchikanti L, Nampiaparampil DE, Manchikanti KN. , et al. Comparison of the efficacy of saline, local anesthetics, and steroids in epidural and facet joint injections for the management of spinal pain: a systematic review of randomized controlled trials. Surg Neurol Int 2015; 6 (Suppl. 04) S194-S235
    CrossrefPubMedGoogle Scholar
  • 32 Manchikanti L, Hirsch JA. Neurological complications associated with epidural steroid injections. Curr Pain Headache Rep 2015; 19 (05) 482
    PubMedGoogle Scholar
  • 33 Gangi A, Tsoumakidou G, Buy X, Cabral JF, Garnon J. Percutaneous techniques for cervical pain of discal origin. Semin Musculoskelet Radiol 2011; 15 (02) 172-180
    Article in Thieme ConnectPubMedGoogle Scholar
  • 34 Manchikanti L, Pampati V, Falco FJE, Hirsch JA. An updated assessment of utilization of interventional pain management techniques in the Medicare population: 2000 - 2013. Pain Physician 2015; 18 (02) E115-E127
    PubMedGoogle Scholar
  • 35 Chou R, Hashimoto R, Friedly J. , et al. Pain Management Injection Therapies for Low Back Pain. Rockville, MD: Agency for Healthcare Research and Quality (US); 2015
    Google Scholar
  • 36 Manchikanti L, Falco FJE, Pampati V, Cash KA, Benyamin RM, Hirsch JA. Cost utility analysis of caudal epidural injections in the treatment of lumbar disc herniation, axial or discogenic low back pain, central spinal stenosis, and post lumbar surgery syndrome. Pain Physician 2013; 16 (03) E129-E143
    PubMedGoogle Scholar
  • 37 Manchikanti L, Benyamin RM. Key safety considerations when administering epidural steroid injections. Pain Manag 2015; 5 (04) 261-272
    CrossrefPubMedGoogle Scholar
  • 38 Bicket MC, Chakravarthy K, Chang D, Cohen SP. Epidural steroid injections: an updated review on recent trends in safety and complications. Pain Manag 2015; 5 (02) 129-146
    CrossrefPubMedGoogle Scholar
  • 39 Kim W, Kim JS, Lim SC, Kim YI, Moon DE. Reversible posterior leukoencephalopathy syndrome after cervical transforaminal epidural steroid injection presenting as transient blindness. Anesth Analg 2011; 112 (04) 967-970
    CrossrefPubMedGoogle Scholar
  • 40 Chiller TM, Roy M, Nguyen D. , et al; Multistate Fungal Infection Clinical Investigation Team. Clinical findings for fungal infections caused by methylprednisolone injections. N Engl J Med 2013; 369 (17) 1610-1619
    CrossrefPubMedGoogle Scholar
  • 41 Iannuccilli JD, Prince EA, Soares GM. Interventional spine procedures for management of chronic low back pain-a primer. Semin Intervent Radiol 2013; 30 (03) 307-317
    Article in Thieme ConnectPubMedGoogle Scholar