Year 2019 / Volume 26 / Number 5


Epidural injections: caudal, interlaminar or transforaminal. More than a shot

Rev. Soc. Esp. Dolor. 2019; 26(5): 255-258 / DOI: 10.20986/resed.2019.3764/2019

Javier de Andrés Ares


1. Manchikanti L1, Pampati V, Falco FJ, Hirsch JA. Growth of spinal interventional pain management techniques: analysis of utilization trends and Medicare expenditures 2000 to 2008. Spine. 2013;38(2):157-68. DOI: 10.1097/BRS.0b013e318267f463.
2. Deyo RA, Mirza SK, Turner JA, Martin BI. Overtreating chronic back pain: time to back off? J Am Board Fam Med. 2009;22(1):62-8. DOI: 10.3122/jabfm.2009.01.080102.
3. Bicket MC, Gupta A, Brown CH, Cohen SP. Epidural Injections for Spinal PainA Systematic Review and Meta-analysis Evaluating the “Control” Injections in Randomized Controlled Trials. Anesthesiologist. 2013;119(4):907-31. DOI: 10.1097/ALN.0b013e31829c2ddd.
4. Watts RW, Silagy CA. A meta-analysis on the efficacy of epidural corticosteroids in the treatment of sciatica. Anaesth Intensive Care. 1995;23(5):564-9. DOI: 10.1177/0310057X9502300506.
5. Gupta AK, Mital VK, Azmi RU. Observations on the management of lumbosciatic syndrome (sciatica) by epidural saline injection. J Indian Med Assoc 1970;54(5):194 6.
6. Bicket, Mark C., et al. Epidural Injections for Spinal PainA Systematic Review and Meta-analysis Evaluating the “Control” Injections in Randomized Controlled Trials. Anesthesiologist. 119.4 (2013): 907-931.
7. McLain RF, Kapural L, Mekhail NA. Epidural steroid therapy for back and leg pain: mechanisms of action and efficacy. Spine J. 2005;5(2):191-201. DOI: 10.1016/j.spinee.2004.10.046.
8. Flower RJ, Blackwell GJ. Anti-inflammatory steroid induced biosynthesis of a phospholipase A2 inhibitor which prevents prostaglandin generation. Nature. 1979;278(5703):456-9. DOI: 10.1038/278456a0.
9. Devor M, Govrin-Lippmann R, Raber P. Corticosteroids suppress ectopic neural discharge originating in experimental neuromas. Pain. 1985;22:127-37. DOI: 10.1016/0304-3959(85)90173-3.
10. Johansson A, Hao J, Sjolund B. Local corticosteroid application blocks transmission in normal nociceptive C-fibers. Acta Anaesthesiol Scand. 1990;34(5):335-8. DOI: 10.1111/j.1399-6576.1990.tb03097.x.
11. Sugimoto M, Uchida I, Mashimo T. Local anaesthetics have different mechanisms and sites of action at the recombinant N‐methyl‐D‐aspartate (NMDA) receptors. Br J Pharmacol. 2003;138(5):876-82.
12. Bogduk N. The innervation of the lumbar spine. Spine 1983;8(3):286-93. DOI: 10.1097/00007632-198304000-00009.
13. Ackerman WE, Ahmad M. The efficacy of lumbar epidural steroid injections in patients with lumbar disc herniations. Anesth Analg. 2007;104(5):1217-22. DOI: 10.1213/01.ane.0000260307.16555.7f.
14. Manchikanti L, Cash KA, Pampati V, McManus CD, Damron KS. Evaluation of fluoroscopically guided caudal epidural injections. Pain Physician 2004;7(1):81-92.
15. Botwin K, Brown LA, Fishman M, Rao S. Fluoroscopically guided caudal epidural steroid injections in degenerative lumbar spine stenosis. Pain Physician. 2007;10(4):547-58.
16. Botwin K, Natalicchio J, Brown LA. Epidurography contrast patterns with fluoroscopic guided lumbar transforaminal epidural injections: a prospective evaluation. Pain Physician. 2004;7(2):211-5.
17. Cannon DT, Aprill CN. Lumbosacral epidural steroid injections. Arch Phys Med Rehabil. 2000;81(3 Suppl 1):S87-98; quiz S99-100.
18. Klocke R, Jenkinson T, Glew D. Sonographically guided caudal epidural steroid injections. J Ultrasound Med. 2003;22(11):1229-32. DOI: 10.7863/jum.2003.22.11.1229.
19. Weil L, Frauwirth NH, Amirdelfan K, Grant D, Rosenberg JA. Fluoroscopic analysis of lumbar epidural contrast spread after lumbar interlaminar injection. Arch Phys Med Rehabil. 2008;89(3):413-6. DOI: 10.1016/j.apmr.2007.08.161.
20. Wagner AL. CT fluoroscopy-guided epidural injections: technique and results. AJNR Am J Neuroradiol. 2004 Nov-Dec;25(10):1821-3.
21. Kao SC, Lin CS. Caudal epidural block: an updated review of anatomy and techniques. Biomed Res Int. 2017;2017:9217145. DOI: 10.1155/2017/9217145.
22. Doshi PP, Jalpa DM. Practice of epidural steroid injections outside of the United States. Techn Reg Anesth Pain Manage. 2009;13(4):258-65.
23. Vydra D, McCormick Z, Clements N, Nagpal A, Julia J, Cushman D. Current Trends in Steroid Dose Choice and Frequency of Administration of Epidural Steroid Injections: A Survey Study. PM R. 2019. DOI: 10.1002/pmrj.12192.
24. Doan L, Patel H, Aronova Y, Gharibo C. Variations in interlaminar epidural steroid injection practice patterns by interventional pain management physicians in the United States. Pain Physician. 2018;21(5):E493-E499.
25. Kennedy DJ, Zheng PZ, Smuck M, McCormick ZL, Huynh L, Schneider BJ. A minimum of 5-year follow-up after lumbar transforaminal epidural steroid injections in patients with lumbar radicular pain due to intervertebral disc herniation. Spine J. 2018;18(1):29-35. DOI: 10.1016/j.spinee.2017.08.264.
26. Brisby H. Pathology and possible mechanisms of nervous system response to disc degeneration. J Bone Joint Surg Am. 2006;88(Suppl 2):68-71. DOI: 10.2106/JBJS.E.01282.
27. Jacobs WC, van Tulder M, Arts M, Rubinstein SM, van Middelkoop M, Ostelo R, et al. Surgery versus conservative management of sciatica due to a lumbar herniated disc: a systematic review. Eur Spine J. 2011;20(4):513-22. DOI: 10.1007/s00586-010-1603-7.
28. Nikolaidis I, Fouyas I, Sandercock P, Statham P. Surgery for cervical radiculopathy or myelopathy. Cochrane Database Syst Rev. 2010;1:CD001466.
29. Ackerman 3rd W, Ahmad M. The efficacy of lumbar epidural steroid injections in patients with lumbar disc herniations. Anesth Analg. 2007;104:1217-22. DOI: 10.1213/01.ane.0000260307.16555.7f.
30. Manchikanti L, Pakanati R, Pampati V. Comparison of three routes of epidural steroid injections in low back pain. Pain Digest. 1999;9:277-285.
31. Gharibo CG, Varlotta GP, Rhame EE, Liu EC, Bendo JA, Perloff MD. Interlaminar versus transforaminal epidural steroids for the treatment of subacute lumbar radicular pain: a randomized, blinded, prospective outcome study. Pain Physician. 2011;14(6):499-511.
32. Jeon JY, Jeong YM, Lee SW, Kim JH, Choi HY, Ahn Y. The Termination Level of the Dural Sac Relevant to Caudal Epidural Block in Lumbosacral Transitional Vertebrae: A Comparison between Sacralization and Lumbarization Groups. Pain Physician. 2018;21(1):73-82.
33. Goodman BS, Posecion LW, Mallempati S, Bayazitoglu M. Complications and pitfalls of lumbar interlaminar and transforaminal epidural injections. Curr Rev Musculoskelet Med 2008;1(3-4):212-22. DOI: 10.1007/s12178-008-9035-2.
34. Zheng P, Schneider BJ, Kennedy DJ, McCormick ZL. Safe Injectate Choice, Visualization, and Delivery for Lumbar Transforaminal Epidural Steroid Injections: Evolving Literature and Considerations. Current Physical Medicine and Rehabilitation Reports 2019:1-8.
35. Furman MB, Cuneo AA. Image and Contrast Flow Pattern Interpretation for Attempted Epidural Steroid Injections. Phys Med Rehabil Clin N Am. 2018;29(1):19-33. DOI: 10.1016/j.pmr.2017.08.003.
36. Conn A, Buenaventura R, Datta S, Abdi S, Diwan S. Systematic review of caudal epidural injections in the management of chronic low back pain. Pain Physician. 2009;12(1):109-135.
37. Boswell MV, Trescot AM, Datta S, Schultz DM, Hansen HC, Abdi S, et al. Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. Pain Physician. 2007;10(1):7-111.
38. Boswell M, Hansen H, Trescot A, Hirsch J. Epidural Steroids in the management of chronic spinal pain. Pain Physician. 2003;6(3):319-34.
39. Staal J, de Bie R, de Vet H, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low back pain: an updated Cochrane Review. Spine. 2009;34(1):49-59. DOI: 10.1097/BRS.0b013e3181909558.
40. Roberts S, Willick S, Rho M, Rittenberg J. Efficacy of lumbosacral transforaminal epidural steroid injections: a systematic review. PMR. 2009;1:657-68.
41. MacVicar J, King W, Landers M, Bogduk N. The effectiveness of lumbar transforaminal injection of steroids: a comprehensive review with systematic analysis of the published data. Pain Med. 2013;14(1):14-28. DOI: 10.1111/j.1526-4637.2012.01508.
42. Park CH, Lee SH, Kim BI. Comparison of the effectiveness of lumbar transforaminal epidural injection with particulate and nonparticulate corticosteroids in lumbar radiating pain. Pain Med. 2010;11(11):1654-8. DOI: 10.1111/j.1526-4637.2010.00941.x.
43. El-Yahchouchi C, Geske JR, Carter RE, Diehn FE, Wald JT, Murthy NS, et al. The noninferiority of the nonparticulate steroid dexamethasone vs the particulate steroids betamethasone and triamcinolone in lumbar transforaminal epidural steroid injections. Pain Med. 2013;14(11):1650-7. DOI: 10.1111/pme.12214.
44. Dietrich TJ, Sutter R, Froehlich JM, Pfirrmann CW. Particulate versus non-particulate steroids for lumbar transforaminal or interlaminar epidural steroid injections: an update. Skeletal Radiol. 2015;44(2):149-55. DOI: 10.1007/s00256-014-2048-6.

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de Andrés Ares J. Epidural injections: caudal, interlaminar or transforaminal. More than a shot. Rev Soc Esp Dolor 2019; 26(5): 255-258 / DOI: 1020986/resed20193764/2019

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Recibido: 15/09/2019

Aceptado: 19/09/2019

Prepublicado: 24/09/2019

Publicado: 07/10/2019

Tiempo de prepublicación: 9 días

Tiempo de edición del artículo: 22 días


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