• 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.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.33 no.3
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• pp.226-233
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• 2020

Background: We aimed to compare interlaminar epidural steroid injections (ILESI) and bilateral transforaminal epidural steroid injections (TFESI) on pain intensity, functional status, depression, walking distance, and the neuropathic component in patients with lumbar central spinal stenosis (LCSS). Methods: The patients were divided into either the ILESI or the bilateral TFESI groups. Prime outcome measures include the numerical rating scale (NRS), Oswestry disability index (ODI), Beck depression inventory (BDI), and pain-free walking distance. The douleur neuropathique en 4 questions score was used as a secondary outcome measure. Results: A total of 72 patients were finally included. NRS, ODI, and BDI scores showed a significant decline in both groups in all follow-ups. Third-month NRS scores were significantly lower in the ILESI group (P = 0.047). The percentages of decrease in the ODI and BDI scores between the baseline and the third week and third month were significantly higher in the ILESI group (P = 0.017, P = 0.001 and P = 0.048, P = 0.030, respectively). Pain-free walking distance percentages from the baseline to the third week and third month were significantly higher in the ILESI group (P = 0.036, P < 0.001). The proportion of patients with neuropathic pain in the bilateral TFESI group significantly decreased in the third week compared to the baseline (P = 0.020). Conclusions: Both ILESI and TFESI are reliable treatment options for LCSS. ILESI might be preferred because of easier application and more effectiveness. However, TFESI might be a better option in patients with more prominent neuropathic pain.

• The Korean Journal of Pain
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• v.35 no.1
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• pp.1-3
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• 2022

• The Journal of the Korean bone and joint tumor society
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• v.12 no.1
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• pp.23-29
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• 2006

Purpose: To evaluate the effectiveness of steroid injection for treatment of simple bone cyst in adults. Materials and Methods: 11 patients who were able to be followed up from February 1998 to February 2003. These lesions were attained by needle aspiration or trepanation and 80 mg to 200 mg of Depo-medrol (methylprednisolone acetate, Shin Poong Pharm. Co., Korea) was injected. The follow-up roentgenograms were done every 2 weeks, and if there were no evidence of recovery, re-injection was done 8 weeks later. Injection has done maximally 5 times, and we evaluated the result with modified Neer, Pentimalli, Scaglietti and Sandra classification. Results: There were no cases in which one Injection was enough for full recovery, and 3 cases after 2 injections, 3 cases after 3 injections, 2 case after 5 injections had good result. but 2 cases after more than 5 injections did not show improvements and are currently under observation. One case showed a increase in size of the bone cyst after 2 injections of steroid and underwent curettage and autogenous bone graft. Overall outcomes by Pentimalli classification were good in One case, fair in 7 cases and poor in 3 cases at final follow-up. Conclusion: Local injection of steroids is effective method in adults and can be considered as a first line treatment modality.

• 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.

• The Korean Journal of Pain
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• v.18 no.2
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• pp.251-254
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• 2005

Spondylolysis, also known as stress injury of pars interarticularis, is a common cause of back pain in athletes, particularly children and young adults. Repeated minor traumas during flexion and extension of the spine are thought to result in bony failure due to excessive bone resorption. These lesions are common in the low back, with the majority found at the L5 vertebra. In the majority of cases of spondylolysis, non-operative treatments are recommended, such as NSAIDs, physiotherapy and bracing. Only if symptoms do not respond to conservative treatments should surgical intervention be considered. Recently, pars interarticularis injections for diagnostic and therapeutic purposes have been found to allow significant pain relief from spondylolysis for long periods. Here, the case of a 57-year-old man with spondylolysis, who suffered from back pain, which was not relieved by an epidural steroid injection, but in whom pars interarticularis injections of local anesthetic and steroid induced complete transient pain relief, following by moderate long-term relief, is presented.

• Journal of Korean Neurosurgical Society
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• v.67 no.2
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• pp.194-201
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• 2024

Objective : This study aimed to evaluate the clinical feasibility of the combination of ultrasound and nerve stimulator guidance in transforaminal epidural steroid injections (TESIs) to manage lumbosacral chronic radicular pain. Methods : Using the combination of nerve stimulator and ultrasound guidance, TESIs were performed in 125 segments of 78 patients who presented with chronic lumbar radicular pain. Demographic characteristics and surgical outcomes were recorded on admission, pre-procedural and post-procedural for 1-week, 1-month, 3-month, and 6-month follow-ups. The result was measured using the Numeric rating scale (NRS) and Oswestry disability index (ODI). Results : Patients who received TESIs showed significant improvements on two evaluation tools (NRS, ODI), compared to that before procedure (p<0.001). No significant complications were observed for 6 months' follow-up. Conclusion : The result suggests that a combination of ultrasound and nerve stimulator guidance in transforaminal epidural injections is safe, reliable and effective for short-term management of lumbar disc herniation. It is a promising technique and has shown good results in providing intermediate pain relief.

• 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.

• 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.