By James P. Rathmell MD
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Extra resources for Atlas of Image-Guided Intervention in Regional Anesthesia and Pain Medicine
Indd 29 9/22/2011 1:33:03 PM 30 Atlas of Image-Guided Intervention in Pain Medicine transforaminal injection of steroid to treat cervical radicular pain is shorter than when a depot formulation of methylprednisolone acetate is employed. However, further studies are needed to ensure the safety and effectiveness of nonparticulate steroids. 5 g) cause effects similar to those seen with local anesthetic overdose: generalized seizures and cardiovascular collapse. Clinical doses up to 1,000 mg are unlikely to cause serious toxicity.
The American Pain Society Low Back Pain Guideline Panel published a report in 2009, concluding, “In patients with persistent radiculopathy due to herniated lumbar disc, it is recommended that clinicians discuss risks and benefits Interlaminar Epidural Injection 39 of epidural steroid injection as an option (weak recommendation, moderate-quality evidence). It is recommended that shared decision making regarding epidural steroid injection include a specific discussion about inconsistent evidence showing moderate short-term benefits, and lack of longterm benefits.
Grainger & Allison’s Diagnostic Radiology. 4th ed. New York: Churchill Livingstone; 2001, with permission. indd 21 9/22/2011 12:23:59 PM 22 Atlas of Image-Guided Intervention in Pain Medicine A B C Figure 3-6. Utility of digital subtraction fluoroscopy for visualization of the gadolinium-based contrast epidurogram. A nonselective epidural steroid injection performed in a 62-year-old male at L4 to L5 employing an interlaminar approach. A: Right anterior oblique projection of the lumbar spine shows a needle (arrow) inserted into the interlaminar space at L4 to L5.