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epidural glucocorticoid injection; epidural steroid injection (ESI)

Indications: - treatment option after failure of more conservative measures - back pain - radiculpathy - sciatica - neck pain Benefit/risk: - epidural steroid injections for sciatica - no clinically significant benefit [4] - no long-term benefit - may have some effect on short-term effect on pain [5] - of no benefit for spinal stenosis [5] Procedure: - injection of glucocorticoid into the epidural space within the spinal column - generally a depot form (or suspension) is injected for sustained release Pharmacokinetics: - suppression of AM serum cortisol at 3 & 6 weeks [3] Complications: - common [4] - headache - vasovagal symptoms - local pain - uncommon [4] - epidural abscesses - bacterial meningitis - epidural hematomas - rare - loss of vision, stroke, paralysis, death [2] - adrenal suppression may persist for >= 3 weeks [3] - high risk for infection after lumbar spine decompression surgery [6]

Specific

cervical/thoracic epidural glucocorticoid/anesthetic injection lumbosacral epidural glucocorticoid/anesthetic injection

General

epidural injection

References

  1. Chen B eMedicine (Medscape): Epidural Steroid Injections http://emedicine.medscape.com/article/325733-overview
  2. FDA MedWatch. April 23, 2014 Epidural Corticosteroid Injection: Drug Safety Communication - Risk of Rare But Serious Neurologic Problems. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm394530.htm - FDA Drug Safety Communication: FDA requires label changes to warn of rare but serious neurologic problems after epidural corticosteroid injections for pain. http://www.fda.gov/downloads/Drugs/DrugSafety/UCM394286.pdf
  3. Friedly JL et al A Randomized Trial of Epidural Glucocorticoid Injections for Spinal Stenosis. N Engl J Med 2014; 371:11-21. July 3, 2014 PMID: 24988555 http://www.nejm.org/doi/full/10.1056/NEJMoa1313265 - Andersson GB Epidural Glucocorticoid Injections in Patients with Lumbar Spinal Stenosis. N Engl J Med 2014; 371:75-76July 3, 2014 PMID: 24988561 http://www.nejm.org/doi/full/10.1056/NEJMe1405475
  4. The NNT: Epidural Steroid Injections for Pain and Disability Associated with Sciatica. http://www.thennt.com/nnt/epidural-steroids-for-sciatica/ - Pinto RZ et al Epidural Corticosteroid Injections in the Management of Sciatica: A Systematic Review and Meta-analysis. Ann Intern Med. 13 November 2012 PMID: 23362516 http://annals.org/article.aspx?articleid=1390546
  5. Chou R, Hashimoto R, Friedly J et al Epidural Corticosteroid Injections for Radiculopathy and Spinal Stenosis: A Systematic Review and Meta-analysis. Ann Intern Med. 2015 Sep 1; 163:373 PMID: 26302454 http://annals.org/article.aspx?articleid=2430207
  6. Lowry F Epidural Steroid Injections Linked to High Risk for Post-Op Infection. Medscape. March 30, 2022 https://www.medscape.com/viewarticle/971241