• The Korean Journal of Pain
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• v.11 no.2
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• pp.210-213
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• 1998

Background: Epidural steroid therapy has been well-established for the treatment of sciatica and low back pain. Disappointing results following surgical decompression or discectomy have led to wide trials of corticosteroids injected either systemically or into the intraspinally. Although epidural steroid is known to be very effective in the treatment of the patients with low back pain, few data showed the therapeutic duration of epidural steroid. Methods: We studied 120 patients who were treated with epidural steroid for the treatment of low back pain or sciatica or both. We retrospectively analysed the duration of analgesia, number of injections per each session, and complications. Results: The duration of analgesia ranged from 17 days to 300 days, and the mean duration was $73.7{\pm}70.5$ (SD) days. The mean number of injections per each session was $1.8{\pm}1.3$ (range: 1 to 12). There were no significant complications with epidural steroid injections. Conclusions: One to three epidural steroid injections at one week interval leads more than two months of pain relief without significant complications.

• The Korean Journal of Pain
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• v.19 no.1
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• pp.72-76
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• 2006

Background: The objective of this study was to describe the extent of pain relief after an epidural steroid injection in the patients suffering from chronic low back pain from herniated disks or lumbar spinal stenosis. Methods: The study was prospectively designed for patients suffering with lumbar spinal stenosis (LSS) and herniated disks (HD) who were referred to a hospital-based pain clinic for epidural steroid injections (ESI). The pain was assessed with using a visual analog scale at baseline, two weeks after the first ESI and two weeks after the third ESI. Results: Eighty patients were enrolled, and all of them provided pain ratings before and after the injections. The LSS patients seemed to improve less than did the HD patients. The results showed no significant differences in the triamcinolone dosage and the frequency of injections for determining the efficacy of ESI. Conclusions: The LSS patients tended to have a less effective respond to ESIs than did the HD patients. The unsatisfactory response to ESI by the LSS patients underscores the need for randomized controlled trials of performing ESI in this population.

• The Korean Journal of Pain
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• v.11 no.1
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• pp.150-154
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• 1998

Epidural steroid injection have become one of the most frequently applied conservative option for the management of acute and chronic back pain. As the indications for epidural steroid injections increase so do the adverse responses associated with this procedure. This study reports the succession of 3 patients who developed galactorrhea and hyperprolactinemia after recieving an epidural steroid injection for lumbar radiculopathy and low back pain. Serum prolactin level was elevated in accordance with epidural injection of corticosteroid. We measured the serum prolactin level by immunoradiometric assay method and peak serum prolactin level at above 500, 144.2, 150.3 ng/ml respectively. Also we found the serum prolactin level decreased to normal values 3 wks after corticosteroid injection. Galactorrhra ceased in advance of decrease of serum prolactin level. That "Hyperprolactinemia and galactorrhea can occur following epidural steroid injection", requires a much larger prospective investigation.

• Journal of Korean Neurosurgical Society
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• v.50 no.2
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• pp.134-138
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• 2011

The authors report a case of epidural and extraforaminal calcification caused by repetitive triamcinolone acetonide injections. A 66-year-old woman was admitted presenting with lower extremity weakness and radiating pain in her left leg. Ten months before admission, the patient was diagnosed as having an L4-5 spinal stenosis and underwent anterior lumbar interbody fusion followed by posterior fixation. Her symptoms had been sustained and she did not respond to transforaminal steroid injections. Repetitive injections (10 times) had been performed on the L4-5 level for six months. She had been taking bisphosphonate as an antiresorptive agent for ten months after surgery. Calcification in the ventral epidural and extraforaminal space was detected. The gritty particles were removed during decompressive surgery and these were proven to be a dystrophic calcification. The patient recovered from weakness and radiating leg pain. Repetitive triamcinolone acetonide injections after discectomy may be the cause of dystrophic calcification not only in the degenerated residual disc, but also in the posterior longitudinal ligament. Possible mechanisms may include the toxicity of preservatives and the insolubility of triamcinolone acetonide. We should consider that repetitive triamcinolone injections in the postdisectomy state may cause intraspinal ossification and calcification.

• The Korean Journal of Pain
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• v.19 no.2
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• pp.175-180
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• 2006

Background: A transforaminal epidural steroid injection has been used for the treatment of radicular arm or leg pain, which has the advantage of ventral epidural spreading compared to either an interlaminar or caudal approach. However, several factors are known to affect the epidural spread pattern of contrast dye; therefore, the injected medication can not be delivered to the target site. The objective of our study was to observe any differences in the contrast flow patterns according to several factors. Methods: A total of 34 epidurographies in 29 patients, who underwent fluoroscopically guided transforaminal epidural steroid injections, were evaluated. After confirming the location of the needle tip within the anterior superior aspect of the neural foramen in the lateral view, and at the 6 o'clock position to the pedicle in the anteroposterior view, 2 ml of contrast dye was injected. The contrast flow patterns of ventral, ventral and dorsal, and dorsal epidural filling were analyzed, according to age, gender, magnetic resonance imaging finding and history of previous back surgery. Results: Ventral contrast flow occurred in 30 out of the 34 epidurographies (88%). Both ventral and dorsal contrast flow patterns were observed 13 out of 16 (81%) patients in the older age group. Also, both ventral and dorsal contrast flow patterns were observed in 16 out of 18 (88%) patients with spinal stenosis. Conclusions: Transforaminal epidural steroid injections, performed uner fluoroscopy, provide excellent nerve root filling and ventral epidural spreading. Patients with spinal stenosis or an old age have both ventral and dorsal epidural spreading patterns.

• The Korean Journal of Pain
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• v.4 no.2
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• pp.152-156
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• 1991

Cervical radiculopathy has been recognized as a common cause of neck, shoulder, and arm pain. It was conventionally treated with rest, traction, cervical collars, manipulation, transcutaneous electrical nerve stimulation, and nonsteroidal anti-inflammatory drugs with varying results. Surgery has not always been successful so the idea of epidural steroid injection was developed as in the case of lumbar epidural injections, for the treatment of low back pain and sciatica. Thirty one patients with evidence of cervical radiculopathy were treated with injections of triamcinolone acetate into the cervical epidural space. The effect of the steroid injection could be evaluated in twenty one patients who received epidural injections more than twice. No improvement was seen in 6 patients and 15 patients showed good to excellent pain relief for a week to over 6 months. Epidural steroid injection seems to have a positive role in the treatment of cervical radiculopathy.

• The Korean Journal of Pain
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• v.23 no.4
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• pp.254-257
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• 2010

Background: Epidural steroid injection is an established treatment modality for intervertebral disc prolapse to radiculopathy. In cases where two levels of radiculopathy are present, two separate injections are warranted. Herein, we present our experience of management of such cases with a single epidural injection of local anaesthetic, tramadol and methylprednisolone, and table tilt for management of both radiculopathies. Methods: 50 patients of either sex aged between 35-65 years presenting with features of cervical and lumbar radiculopathic pain were included and were subjected to single lumbar epidural injection of local anaesthetic, tramadol and methylprednisolone, in the lateral position. The table was then tilted in the trendelberg position with a tilt of 25 degrees, and patients were maintained for 10 minuted before being turned supine. All patients were administered 3 such injections with an interval of 2 weeks between subsequent injections, and pain relief was assessed with a visual analogue scale. Immediate complications after the block were assessed. Results: Immediate and post procedural complications observed were nausea and vomiting (20%), painful injection site (4%), hypotension (10%) and high block (4%). Pain relief was assessed after the three injections by three grades: 37 (74%) had complete resolution of symptoms; 18% had partial relief and 8% did not benefit from the procedure. Conclusions: This technique may be used as an alternative technique for pain relief in patients with unilateral cervical and lumbar radiculopathies.

• The Korean Journal of Pain
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• v.7 no.2
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• pp.231-237
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• 1994

Epidural steroid injection is a treatment for low back pain which allows smaller doses with less risk of side effects and longer duration of relief than systemic administration. From 1 June 1992 to 31 January, 1994, 1 mg/kg of triamcinolone diacetate in 8 ml of lidocaine 1% was administered 56 times to 33 patients who complained of low back pain. Results of epidural steroid injection provided effectiveness in treating various low back pain diseases except postlaminectomy syndrome. However there are no gains about repeated epidural steroid injection.

• Journal of Korean Neurosurgical Society
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• v.29 no.3
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• pp.420-425
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• 2000

Epidural steroid injection(ESI) has been a commonly applied conservative therapy for the management of chronic low back pain and sciatica. However, there are many reports concerning various local, systemic and neurological complications related to ESI. We report two cases with fatal complications after ESI for low back pain and sciatica. In both patients, ventriculitis and meningitis were causative factors to be fatal. Aseptic procedures and careful post-procedure assessment are essential to avoid serious complications following ESI.

• The Korean Journal of Pain
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• v.28 no.1
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• pp.11-21
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• 2015

Background: Epidural injections are performed utilizing 3 approaches in the lumbar spine: caudal, interlaminar, and transforaminal. The literature on the efficacy of epidural injections has been sporadic. There are few high-quality randomized trials performed under fluoroscopy in managing disc herniation that have a long-term follow-up and appropriate outcome parameters. There is also a lack of literature comparing the efficacy of these 3 approaches. Methods: This manuscript analyzes data from 3 randomized controlled trials that assessed a total of 360 patients with lumbar disc herniation. There were 120 patients per trial either receiving local anesthetic alone (60 patients) or local anesthetic with steroids (60 patients). Results: Analysis showed similar efficacy for caudal, interlaminar, and transforaminal approaches in managing chronic pain and disability from disc herniation. The analysis of caudal epidural injections showed the potential superiority of steroids compared with local anesthetic alone a 2-year follow-up, based on the average relief per procedure. In the interlaminar group, results were somewhat superior for pain relief in the steroid group at 6 months and functional status at 12 months. Interlaminar epidurals provided improvement in a significantly higher proportion of patients. The proportion of patients nonresponsive to initial injections was also lower in the group for local anesthetic with steroid in the interlaminar trial. Conclusions: The results of this assessment show significant improvement in patients suffering from chronic lumbar disc herniation with 3 lumbar epidural approaches with local anesthetic alone, or using steroids with long-term follow-up of up to 2 years, in a contemporary interventional pain management setting.