Epidural Steroid Injection [Neurosurgery Wiki]

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====== Epidural Steroid Injection ======

===== Indications =====

[[Epidural]] [[steroid injection]]s (ESIs) are a common method for back pain management and treating [[inflammation]] associated with low back related leg [[pain]], or neck related [[arm pain]]. In both of these conditions, the [[spinal nerve]]s become inflamed due to narrowing of the passages where the [[nerve]]s travel as they pass down or out of the [[spine]]. 

[[Epidural Steroid Injection for chronic low back pain]]
===== History =====
They have been used in the treatment of lumbar [[radicular pain]] syndromes since [[1952]]. These injections have been performed blind, using an interlaminar loss of resistance technique with a 13-30% incidence of improper localization of the space

X-ray confirmation of site is essential for difficult extradural blocks, or when neurolytic solutions are introduced into the [[spinal canal]]
((Mehta M, Salmon N. Extradural block. Confirmation of the injection site by
X-ray monitoring. Anaesthesia. 1985 Oct;40(10):1009-12. PubMed PMID: 4061788.)).


====Types====

[[Interlaminar epidural steroid injection]]

[[Transforaminal epidural steroid injection]] 

see [[Lumbar epidural injection]]

see [[Cervical epidural injection]]

see [[Caudal epidural injection]]

===== Complications =====

see [[Epidural Steroid Injection Complications]].

===== Case series =====
One hundred forty-one patients met the inclusion/exclusion criteria; 89 received [[Epidural Steroid Injection]] (ESI) and 52 were treated with medical [[management]] alone. Both [[cohort]]s showed improved [[EQ-5D]] scores at 3 months but were similar to one another: ESI (ΔEQ-5D = 0.06; p = 0.03) and medical-alone (ΔEQ-5D = 0.07; p = 0.03). No significant difference was seen between groups for total [[cost]]s ($2,190 vs. $1,772; p = 0.18) or cost-utility ratios ($38,710/QALY vs. $27,313/QALY; p = 0.73). At both the 3-month and 6-month endpoints, absolute differences in cost-utility were driven by overall costs as opposed to QALY gains. Medical management alone was more cost-effective at both points owing to lower expenditures, however, these differences were not significant. No benefits were seen in either group on the EQ-5D or any of the patient-reported outcomes at the 6-month time point.

ESIs were not cost-effective at either the 3-month or 6-month follow-up period. At 3 months, ESIs provide similar improvements in QOL outcomes relative to medical management and at similar costs. At 6 months, neither ESIs nor conservative management provides significant improvements in [[QOL]] outcomes
((Pennington Z, Swanson MA, Lubelski D, Mehta V, Alvin MD, Fuhrman H, Benzel EC,
Mroz TE. Comparing the short-term cost-effectiveness of epidural steroid
injections and medical management alone for discogenic lumbar radiculopathy. Clin
Neurol Neurosurg. 2020 Jan 13;191:105675. doi: 10.1016/j.clineuro.2020.105675.
[Epub ahead of print] PubMed PMID: 31954364.
)).

===== References =====