The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
권호 표지
DOI QR코드

DOI QR Code

Quantitative assessment of steroid amount in the tissue after epidural steroid injection: a new rabbit model

  • Cho, Jungheum (Department of Radiology, Seoul National University Bundang Hospital) ;
  • Lee, Joon Woo (Department of Radiology, Seoul National University Bundang Hospital) ;
  • Lee, Eugene (Department of Radiology, Seoul National University Bundang Hospital) ;
  • Kang, Yusuhn (Department of Radiology, Seoul National University Bundang Hospital) ;
  • Cho, Ha Ra (College of Pharmacy, Dankook University) ;
  • Kim, Dong Yoon (College of Pharmacy, Dankook University) ;
  • Ho, Myoung Jin (College of Pharmacy, Dankook University) ;
  • Kang, Myung Joo (College of Pharmacy, Dankook University) ;
  • Choi, Yong Seok (College of Pharmacy, Dankook University)
  • Received : 2019.02.22
  • Accepted : 2019.05.16
  • Published : 2019.10.01
Download PDF
⟨ Previous Next ⟩

Abstract

Background: To develop a rabbit epidural steroid injection (ESI) model for analyzing steroid retention in the tissue, and to assess the difference in steroid retention in the model according to the location and time elapsed after ESI. Methods: Fluoroscopy-guided ESI was performed using the interlaminar approach between the lowest two lumbar segments in 13 female New Zealand white rabbits. Four rabbits were allocated to each of three different groups according to the time of sacrifice: 3, 7, and 15 days post-ESI; the remaining rabbit was sacrificed immediately post-ESI to obtain baseline data. After sacrifice, two segments were harvested: the lowest two lumbar vertebrae and another two lumbar vertebrae immediately above these. The residual steroid amount (RSA) and residual steroid concentration (RSC) in the collected spinal columns were analyzed. A linear mixed model was used to compare RSAs and RSCs between the injected and adjacent segments, and among the number of days until sacrifice; P < 0.05 was considered statistically significant. Results: Both RSA and RSC of the injected segment were significantly higher than those of the adjacent segment (P < 0.001, both). The RSA and RSC significantly decreased over time (P = 0.009 and P = 0.016, respectively). Conclusions: The developed rabbit ESI model verified that significantly more steroid was retained at the injected segment than at the adjacent segment and the residual steroid decreased over time. This model could be useful not only for comparing current steroid medications, but also for developing new, better steroid formulations.

Keywords

References

  1. Jacobs JM, Hammerman-Rozenberg R, Cohen A, Stessman J. Chronic back pain among the elderly: prevalence, associations, and predictors. Spine (Phila Pa 1976) 2006; 31: E203-7. https://doi.org/10.1097/01.brs.0000206367.57918.3c
  2. Manchikanti L, Pampati V, Falco FJ, Hirsch JA. An updated assessment of utilization of interventional pain management techniques in the Medicare population: 2000 - 2013. Pain Physician 2015; 18: E115-27. https://doi.org/10.36076/ppj/2015.18.E115
  3. Chou R, Loeser JD, Owens DK, Rosenquist RW, Atlas SJ, Baisden J, et al. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. Spine (Phila Pa 1976) 2009; 34: 1066-77. https://doi.org/10.1097/BRS.0b013e3181a1390d
  4. Manchikanti L, Benyamin RM, Falco FJ, Kaye AD, Hirsch JA. Do epidural injections provide short- and long-term relief for lumbar disc herniation? A systematic review. Clin Orthop Relat Res 2015; 473: 1940-56. https://doi.org/10.1007/s11999-014-3490-4
  5. Friedly JL, Comstock BA, Turner JA, Heagerty PJ, Deyo RA, Sullivan SD, et al. A randomized trial of epidural glucocorticoid injections for spinal stenosis. N Engl J Med 2014; 371: 11-21. https://doi.org/10.1056/NEJMoa1313265
  6. Kennedy DJ, Plastaras C, Casey E, Visco CJ, Rittenberg JD, Conrad B, et al. Comparative effectiveness of lumbar transforaminal epidural steroid injections with particulate versus nonparticulate corticosteroids for lumbar radicular pain due to intervertebral disc herniation: a prospective, randomized, double-blind trial. Pain Med 2014; 15: 548-55. https://doi.org/10.1111/pme.12325
  7. Kreiner DS, Shaffer WO, Baisden JL, Gilbert TJ, Summers JT, Toton JF, et al.; North American Spine Society. An evidencebased clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis (update). Spine J 2013; 13: 734-43. https://doi.org/10.1016/j.spinee.2012.11.059
  8. Kim JY, Lee JW, Lee GY, Lee E, Yoon CJ, Kang HS. Comparative effectiveness of lumbar epidural steroid injections using particulate vs. non-particulate steroid: an intra-individual comparative study. Skeletal Radiol 2016; 45: 169-76. https://doi.org/10.1007/s00256-015-2277-3
  9. Lee JW, Park KW, Chung SK, Yeom JS, Kim KJ, Kim HJ, et al. Cervical transforaminal epidural steroid injection for the management of cervical radiculopathy: a comparative study of particulate versus non-particulate steroids. Skeletal Radiol 2009; 38: 1077-82. https://doi.org/10.1007/s00256-009-0735-5
  10. Suresh S, Berman J, Connell DA. Cerebellar and brainstem infarction as a complication of CT-guided transforaminal cervical nerve root block. Skeletal Radiol 2007; 36: 449-52. https://doi.org/10.1007/s00256-006-0215-0
  11. Wybier M, Gaudart S, Petrover D, Houdart E, Laredo JD. Paraplegia complicating selective steroid injections of the lumbar spine. Report of five cases and review of the literature. Eur Radiol 2010; 20: 181-9. https://doi.org/10.1007/s00330-009-1539-7
  12. Benzon HT, Huntoon MA, Rathmell JP. Improving the safety of epidural steroid injections. JAMA 2015; 313: 1713-4. https://doi.org/10.1001/jama.2015.2912
  13. Parkin IG, Harrison GR. The topographical anatomy of the lumbar epidural space. J Anat 1985; 141: 211-7.
  14. Qureshi AI, Qureshi MH, Malik AA, Khan AA, Sohail A, Saed A, et al. Catheter-based transepidural approach to cervical and thoracic posterior and perineural epidural spaces: a cadaveric feasibility study. J Vasc Interv Neurol 2015; 8: 43-9.
  15. Reina MA, Franco CD, Lopez A, De Andres JA, van Zundert A. Clinical implications of epidural fat in the spinal canal. A scanning electron microscopic study. Acta Anaesthesiol Belg 2009; 60: 7-17.
  16. Madsen JB, Jensen FM, Faber T, Bille-Hansen V. Chronic catheterization of the epidural space in rabbits: a model for behavioural and histopathological studies. Examination of meptazinol neurotoxicity. Acta Anaesthesiol Scand 1993; 37: 307-13. https://doi.org/10.1111/j.1399-6576.1993.tb03720.x
  17. Robecchi A, Capra R. Hydrocortisone (compound F); first clinical experiments in the field of rheumatology. Minerva Med 1952; 43: 1259-63.
  18. Beall DP, Deer TR, Wilsey JT, Walsh AJ, Block JH, McKay WF, et al. Tissue distribution of clonidine following intraforaminal implantation of biodegradable pellets: potential alternative to epidural steroid for radiculopathy. Pain Physician 2012; 15: E701-10.
  19. Baqai A, Bal R. The mechanism of action and side effects of epidural steroids. Tech Reg Anesth Pain Manag 2009; 13: 205-11. https://doi.org/10.1053/j.trap.2009.06.009
  20. Kim EJ, Moon JY, Park KS, Yoo da H, Kim YC, Sim WS, et al. Epidural steroid injection in Korean pain physicians: a national survey. Korean J Pain 2014; 27: 35-42. https://doi.org/10.3344/kjp.2014.27.1.35