Lumbar Epidural Steroid Injections

JBJS Essential Surgical Techniques
Enrique PenaDevender Singh

Abstract

Lumbar radiculopathy is a common diagnosis for patients who present with low-back pain and leg pain, typically along a particular dermatome. This pain is commonly associated with a lumbar disc herniation. The prognosis is usually favorable, and the symptoms can resolve spontaneously over time. In patients in whom leg and back symptoms are severe, lumbar epidural (cortico)steroid injections are good options for the short to medium-term management of pain. Currently, lumbar epidural steroid injections are performed with radiographic guidance systems and fluoroscopy. This method is preferred because of the increased accuracy in needle placement and the reduced risk of injury to nerves and vascular structures. The procedure is performed with the following steps: (1) Following appropriate patient selection through clinical evaluation and assessment of imaging studies such as computed tomography or magnetic resonance imaging, the patient is prepared and draped after providing written informed consent. (2) The level of neural compression to be injected is identified with intermittent fluoroscopy and the use of a radiopaque marker. (3) The skin and subcutaneous tissues are anesthetized. (4) A spinal needle (Quincke or Tuohy type) is in...Continue Reading

References

Apr 29, 2009·The Spine Journal : Official Journal of the North American Spine Society·Deborah L RabinovitchAndrea D Furlan
May 27, 2009·Current Reviews in Musculoskeletal Medicine·Bradly S GoodmanMatt Bayazitoglu
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Feb 5, 2011·Physical Medicine and Rehabilitation Clinics of North America·Monica E Rho, Chi-Tsai Tang
Mar 12, 2011·Pain Medicine : the Official Journal of the American Academy of Pain Medicine·Jacob M McGrathDaniel M Malkamaki
Dec 21, 2013·Anesthesia and Analgesia·Boqing ChenPatrick M Foye
Feb 12, 2014·Clinical Orthopaedics and Related Research·Laxmaiah ManchikantiJoshua A Hirsch
Mar 20, 2015·Anesthesiology and Pain Medicine·Laxmaiah ManchikantiJoshua Hirsch

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