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Steven P Cohen - One of the best experts on this subject based on the ideXlab platform.
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lumbosacral Radiculopathy inciting events and their association with epidural steroid injection outcomes
Pain Medicine, 2019Co-Authors: Alyson M Engle, Yian Chen, Bryan J Marascalchi, Indy Wilkinson, Winfred B Abrams, Cathy He, Peju Adekoya, Zared Orion Cohen, Steven P CohenAbstract:OBJECTIVE: Low back pain is the leading cause of worldwide disability, with lumbosacral Radiculopathy accounting for over one-third of these cases. There are limited data on the relationship between etiologies and lumbosacral Radiculopathy, and it is unknown whether specific causes predict treatment outcomes. DESIGN, SETTING, AND SUBJECTS: This study explores patient-reported etiologies for lumbosacral Radiculopathy in a chronic pain clinic between January 2007 and December 2015 and examines whether these causes affected epidural steroid injection outcomes. METHODS: We reviewed the medical records of 1,242 patients with lumbosacral Radiculopathy who received epidural steroid injections. The recording of an inciting event was done contemporaneously based on note templates. A positive outcome following an epidural steroid injection was defined as ≥30% pain relief sustained for six or more weeks without additional intervention. Factors associated with epidural steroid injection outcome were analyzed by multivariable logistic regression. RESULTS: Fifty point seven percent reported an inciting event, and 59.9% of patients experienced a positive epidural steroid injection outcome. The most commonly reported causes were falls (13.1%), motor vehicle collisions (10.7%), and lifting (7.8%). Individuals with a herniated disc (56.3%) were more likely to report a precipitating cause than those with stenosis (44.7%) or degenerative discs (47.8%, P = 0.012). An inciting event did not predict treatment outcome. Factors associated with negative treatment outcome included opioid consumption (odds ratio [OR] = 0.61, 95% confidence interval [CI] = 0.39-0.95, P = 0.027), secondary gain (OR = 0.69, 95% CI = 0.50-0.96, P = 0.030), and baseline pain score (OR = 0.90, 95% CI = 0.84-0.97, P = 0.006). The number of levels injected was associated with a positive outcome (OR = 2.72, 95% CI = 1.28-6.47, P = 0.008). CONCLUSIONS: Reported inciting events are common in patients with lumbosacral Radiculopathy but are not associated with outcome following epidural steroid injection, and their occurrence is not always consistent with the purported mechanism of injury.
Frank P Cammisa - One of the best experts on this subject based on the ideXlab platform.
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transforaminal epidural steroid injections in lumbosacral Radiculopathy a prospective randomized study
Spine, 2002Co-Authors: Atul L Bhat, Gregory E Lutz, Frank P CammisaAbstract:Study Design. A prospective study randomized by patient choice from the private practice of a single physician affiliated with a major teaching hospital was conducted. Objectives. To compare transforaminal epidural steroid injections with saline trigger-point injections used in the treatment of lumbosacral radicuiopathy secondary to a herniated nucleus pulposus. Summary of Background Data. Epidural steroid injections have been used for more than half a century in the management of lumbosacral radicular pain. At this writing, however, there have been no controlled prospective trials of transforaminal epidural steroid injections in the treatment of lumbar radicuiopathy secondary to a herniated nucleus pulposus. Methods. Randomized by patient choice, patients received either a transforaminal epidural steroid injection or a saline trigger-point injection. Treatment outcome was measured using a patient satisfaction scale with choice options of 0 (poor), 1 (fair), 2 (good), 3 (very good), and 4 (excellent); a Roland-Morris low back pain questionnaire that showed improvement by an increase in score; a measurement of finger-to-floor distance with the patient in fully tolerated hip flexion; and a visual numeric pain scale ranging from 0 to 10. A successful outcome required a patient satisfaction score of 2 (good) or 3 (very good), improvement on the Roland-Morris score of 5 or more, and pain reduction greater than 50% at least 1 year after treatment. The final analysis included 48 patients with an average follow-up period of 16 months (range, 12-21 months). Results. After an average follow-up period of 1.4 years, the group receiving transforaminal epidural steroid injections had a success rate of 84%, as compared with 48% for the group receiving trigger-point injections (P < 0.005). Conclusion. Fluoroscopically guided transforaminal injections serve as an important tool in the nonsurgical management of lumbosacral Radiculopathy secondary to a herniated nucleus pulposus.
Gregory E Lutz - One of the best experts on this subject based on the ideXlab platform.
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effectiveness of transforaminal epidural steroid injections in patients with degenerative lumbar scoliotic stenosis and Radiculopathy
Pain Physician, 2004Co-Authors: Grant Cooper, Gregory E Lutz, Oheneba BoachieadjeiAbstract:BACKGROUND: The use of epidural steroid injections as a treatment for patients with degenerative lumbar scoliotic spinal stenosis and Radiculopathy has received sparse attention in the literature. Even though it has been reported that patients with scoliosis may respond differently than other patient groups to conservative therapeutic interventions for low back pain and Radiculopathy, patients with scoliosis have rarely, if ever, been excluded from clinical studies of epidural steroid injections. To date, there are no studies investigating the efficacy of fluoroscopic transforaminal epidural steroid injections as a treatment for patients with Radiculopathy and radiographic evidence of degenerative lumbar scoliotic stenosis. OBJECTIVE: To evaluate the effectiveness of fluoroscopically guided transforaminal epidural steroid injections as a conservative treatment for patients with degenerative lumbar scoliotic stenosis and Radiculopathy. DESIGN: Retrospective case series. METHODS: The study was performed in an academic outpatient physical medicine and rehabilitation spine practice. Participants included 61 patients with radiographic evidence of degenerative lumbar scoliotic stenosis and Radiculopathy. Patients who had undergone at least one fluoroscopic-guided transforaminal epidural steroid and anesthetic injection were included. MAIN OUTCOME MEASURES: Numeric Rating Scale (NRS) for worst pain experienced, North American Spine Society (NASS) satisfaction scale, amount of pain medication used, and adapted Stucki questionnaire to assess function and pain status. RESULTS: We obtained follow-up on 52 (85.2%) of 61 included patients. We defined a successful outcome as a patient who was both satisfied with his or her results and experienced at least a 2-points improvement in NRS, Summary Pain, and Summary Function scores. Using these criteria for success, 59.6% of our patients had a successful outcome at one week post-injection, 55.8% at one month post-injection, 37.2% at one year post-injection, and 27.3% had a successful outcome at two years post-injection (p < 0.01). CONCLUSION: Fluoroscopic transforaminal epidural steroid injections appear to be an effective nonsurgical treatment option for patients with degenerative lumbar scoliotic stenosis and Radiculopathy and should be considered before surgical intervention.
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transforaminal epidural steroid injections in lumbosacral Radiculopathy a prospective randomized study
Spine, 2002Co-Authors: Atul L Bhat, Gregory E Lutz, Frank P CammisaAbstract:Study Design. A prospective study randomized by patient choice from the private practice of a single physician affiliated with a major teaching hospital was conducted. Objectives. To compare transforaminal epidural steroid injections with saline trigger-point injections used in the treatment of lumbosacral radicuiopathy secondary to a herniated nucleus pulposus. Summary of Background Data. Epidural steroid injections have been used for more than half a century in the management of lumbosacral radicular pain. At this writing, however, there have been no controlled prospective trials of transforaminal epidural steroid injections in the treatment of lumbar radicuiopathy secondary to a herniated nucleus pulposus. Methods. Randomized by patient choice, patients received either a transforaminal epidural steroid injection or a saline trigger-point injection. Treatment outcome was measured using a patient satisfaction scale with choice options of 0 (poor), 1 (fair), 2 (good), 3 (very good), and 4 (excellent); a Roland-Morris low back pain questionnaire that showed improvement by an increase in score; a measurement of finger-to-floor distance with the patient in fully tolerated hip flexion; and a visual numeric pain scale ranging from 0 to 10. A successful outcome required a patient satisfaction score of 2 (good) or 3 (very good), improvement on the Roland-Morris score of 5 or more, and pain reduction greater than 50% at least 1 year after treatment. The final analysis included 48 patients with an average follow-up period of 16 months (range, 12-21 months). Results. After an average follow-up period of 1.4 years, the group receiving transforaminal epidural steroid injections had a success rate of 84%, as compared with 48% for the group receiving trigger-point injections (P < 0.005). Conclusion. Fluoroscopically guided transforaminal injections serve as an important tool in the nonsurgical management of lumbosacral Radiculopathy secondary to a herniated nucleus pulposus.
Oheneba Boachieadjei - One of the best experts on this subject based on the ideXlab platform.
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effectiveness of transforaminal epidural steroid injections in patients with degenerative lumbar scoliotic stenosis and Radiculopathy
Pain Physician, 2004Co-Authors: Grant Cooper, Gregory E Lutz, Oheneba BoachieadjeiAbstract:BACKGROUND: The use of epidural steroid injections as a treatment for patients with degenerative lumbar scoliotic spinal stenosis and Radiculopathy has received sparse attention in the literature. Even though it has been reported that patients with scoliosis may respond differently than other patient groups to conservative therapeutic interventions for low back pain and Radiculopathy, patients with scoliosis have rarely, if ever, been excluded from clinical studies of epidural steroid injections. To date, there are no studies investigating the efficacy of fluoroscopic transforaminal epidural steroid injections as a treatment for patients with Radiculopathy and radiographic evidence of degenerative lumbar scoliotic stenosis. OBJECTIVE: To evaluate the effectiveness of fluoroscopically guided transforaminal epidural steroid injections as a conservative treatment for patients with degenerative lumbar scoliotic stenosis and Radiculopathy. DESIGN: Retrospective case series. METHODS: The study was performed in an academic outpatient physical medicine and rehabilitation spine practice. Participants included 61 patients with radiographic evidence of degenerative lumbar scoliotic stenosis and Radiculopathy. Patients who had undergone at least one fluoroscopic-guided transforaminal epidural steroid and anesthetic injection were included. MAIN OUTCOME MEASURES: Numeric Rating Scale (NRS) for worst pain experienced, North American Spine Society (NASS) satisfaction scale, amount of pain medication used, and adapted Stucki questionnaire to assess function and pain status. RESULTS: We obtained follow-up on 52 (85.2%) of 61 included patients. We defined a successful outcome as a patient who was both satisfied with his or her results and experienced at least a 2-points improvement in NRS, Summary Pain, and Summary Function scores. Using these criteria for success, 59.6% of our patients had a successful outcome at one week post-injection, 55.8% at one month post-injection, 37.2% at one year post-injection, and 27.3% had a successful outcome at two years post-injection (p < 0.01). CONCLUSION: Fluoroscopic transforaminal epidural steroid injections appear to be an effective nonsurgical treatment option for patients with degenerative lumbar scoliotic stenosis and Radiculopathy and should be considered before surgical intervention.
Atul L Bhat - One of the best experts on this subject based on the ideXlab platform.
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transforaminal epidural steroid injections in lumbosacral Radiculopathy a prospective randomized study
Spine, 2002Co-Authors: Atul L Bhat, Gregory E Lutz, Frank P CammisaAbstract:Study Design. A prospective study randomized by patient choice from the private practice of a single physician affiliated with a major teaching hospital was conducted. Objectives. To compare transforaminal epidural steroid injections with saline trigger-point injections used in the treatment of lumbosacral radicuiopathy secondary to a herniated nucleus pulposus. Summary of Background Data. Epidural steroid injections have been used for more than half a century in the management of lumbosacral radicular pain. At this writing, however, there have been no controlled prospective trials of transforaminal epidural steroid injections in the treatment of lumbar radicuiopathy secondary to a herniated nucleus pulposus. Methods. Randomized by patient choice, patients received either a transforaminal epidural steroid injection or a saline trigger-point injection. Treatment outcome was measured using a patient satisfaction scale with choice options of 0 (poor), 1 (fair), 2 (good), 3 (very good), and 4 (excellent); a Roland-Morris low back pain questionnaire that showed improvement by an increase in score; a measurement of finger-to-floor distance with the patient in fully tolerated hip flexion; and a visual numeric pain scale ranging from 0 to 10. A successful outcome required a patient satisfaction score of 2 (good) or 3 (very good), improvement on the Roland-Morris score of 5 or more, and pain reduction greater than 50% at least 1 year after treatment. The final analysis included 48 patients with an average follow-up period of 16 months (range, 12-21 months). Results. After an average follow-up period of 1.4 years, the group receiving transforaminal epidural steroid injections had a success rate of 84%, as compared with 48% for the group receiving trigger-point injections (P < 0.005). Conclusion. Fluoroscopically guided transforaminal injections serve as an important tool in the nonsurgical management of lumbosacral Radiculopathy secondary to a herniated nucleus pulposus.