Steroid Injection For Treatment Research Articles

EPIDURAL STEROID INJECTION THERAPY FOR LOW BACK PAIN: A META-ANALYSIS

The aim of this study was to systematically assess the long-term (≥ 6 months) benefits of epidural steroid injection therapies for patients with low back pain. We identified randomized controlled trials by database searches up to October 2011 and by additional hand searches without language restrictions. Randomized controlled trials on the effects of epidurals for low back pain with follow-up for at least 6 months were included. Outcomes considered were pain relief, functional improvement in 6 to 12 months after epidural steroid injection treatment and the number of patients who underwent subsequent surgery. Meta-analysis was performed using a random-effects model. Twenty-nine articles were selected. The meta-analysis suggested that a significant treatment effect on pain was noted at 6 months of follow-up (weighted mean difference [WMD], -0.41; 95 percent confidence interval [CI], -0.66 to -0.16), but was no longer statistically significant after adjusting for the baseline pain score (WMD, -0.19; 95 percent CI, -0.61 to 0.24). Epidural steroid injection did not improve back-specific disability more than a placebo or other procedure. Epidural steroid injection did not significantly decrease the number of patients who underwent subsequent surgery compared with a placebo or other treatments (relative risk, 1.02; 95 percent CI, 0.83 to 1.24). A long-term benefit of epidural steroid injections for low back pain was not suggested at 6 months or longer. Introduction of selection bias in the majority of injection studies seems apparent. Baseline adjustment is essential when we evaluate pain as a main outcome of injection therapy.

SAT0433 In 56 biopsies from non-ruptured tendinopathic achilles tendons, the presence of T and B lymphocytes, macrophages and NK cells was localized by immunohistochemistry. The amount of B lymphocytes and NK cells correlated to disease duration

BackgroundThe etiology of Achilles tendinopathy still remains unclear. Limited data exists on whether immune-competent cells are present in the tendon.ObjectivesTo evaluate the presence of T and B lymphocytes, NK cells...

Aspiration and metilprednisolone injection to the cavity with branule needle in the treatment of volar wrist ganglia:new technique

Objective: There are several types of treatment modalities for wrist ganglions. The aim of the study was to assess the effectiveness of cyst aspiration and methyl prednisolone acetate injection with double IV cannula rather than sharp pointed needle, as a new technique in the treatment of volar ganglia. Methodology: The study involves total of 19 patients who received treatment by aspiration and methyl prednisolone injection into the cavity. Two IV cannulas are pricked to the cystic cavity. Cyst fluid is drained by the distally placed IV cannula meanwhile injecting methyl prednisolone by proximally placed IV cannula. The patient records and follow-up reports are retrospectively investigated. The patient age, sex, site of the cyst, the treatment that was applied, adjacency to the artery and the nerves and recurrence are recorded. Mean follow up time was 2.1±0.5 years. Results: The study involved 19 patients that received aspiration treatment for volar ganglion cysts between January 2004 and December 2009. There were 12 (63.2%) female and 7 (36.8%) male subject with volar wrist ganglion cyst. The mean age of patients was 27.63±6.6 years. Fourteen (73.7%) patients of total had cysts close to the artery. We didn’t observe any complication related to methyl prednisolone injection and arterial ischemia. Recurrence was observed in three (15.8%) patients. Conclusion: This method has lower recurrence rate than other aspiration therapy with sharp pointed needle. We prefer to use IV cannula needle for cyst aspiration and steroid injection in treatment of volar ganglia before any surgical intervention.

The effectiveness of volume versus concentration of the epidural steroid injections through transforaminal approach

BackgroundThe use of transforaminal epidural injections under fluoroscopy guarantees the proper delivery of steroids to the target site with the least volume. The aim of this study was to compare the effects of different volumes of epidural steroid injections for treatment of sciatica through transforaminal approach.Methods60 ASA I–II patients complaining of unilateral radiculopathy were divided randomly into three equal groups (group A–C), to be given transforaminal injection under fluoroscopy. All patients received a mixture of (80 mg methylprednisolone acetate + 1 ml contrast dye of Omnipaque 300) plus 1 ml of 0.5% bupivacaine (group A), or 2 ml of 0.5% bupivacaine (group B), or 3 ml of 0.5% bupivacaine (group C).ResultsThere was significant reduction in the (VAS) score, at 60 minutes (group A 2.3 ± 1.1, group B 2.7 ± 0.8 and group C 3 ± 0.8 p < 0.01). Patients in group A had significantly lower VAS score (3.9 ± 1) in relation to the groups B VAS score (4.7 ± 1.1) and C (5 ± 1.1) two weeks after the injection (p < 0.01).In group A, sixteen patients showed a significant reduction in the frequency of analgesic intake in the follow up period, while eleven patients reduced the frequency of analgesic intake during the 2 weeks follow up period, in group B. As for group C, twelve patients remained on the same frequency of analgesic intake following injection. Patients in group A showed significant reduction in the need for surgery.ConclusionPatients receiving a low volume and high concentration of corticosteroid via transforaminal epidural approach for the treatment of symptomatic lumbar disc herniation or spinal stenosis had significantly better short-term pain improvement, and less incidence of need for surgical intervention, than patients who were treated with a diluted solution of corticosteroid.

Clinical outcomes of steroid injection for treatment of pediatric trigger thumbs

Objective To analyze the clinical effectiveness of steroid injection for treatment of pediatric trigger thumbs. Methods From August 2007 to February 2009, there were 47 trigger thumbs ( 15 right thumbs, 20 left thumbs, 6 bilateral) in41 children (15 boys, 26 girls), that had been treated with steroid injection in our hospital. The steroid injection was performed once a week for a total of 2 or 3 times. The age at initial diagnosis ranged from 20 months to 5 years old, and the age at initial onset ranged from 1 week to 4 years.The severity of the trigger thumbs was classified using Sugimoto classification: there were 27 thumbs at stage Ⅱ,17 thumbs at stage Ⅲ, and 3 thumbs at stage Ⅳ. Results Two thumbs of stage Ⅱ were lost to follow-up. The rest 39 cases and 45 thumbs were followed for 12 to 18 months, with an average of 14 months. Symptom alleviation was noticed 2 weeks after the injection. The overall effective rate was 82.2%. No complication was found in injection sites. Conclusion It is a rapid and effective way to treat pediatric trigger thumbs with steroid injection. Key words: Child; Blocking therapy; Trigger thumb

Comparison of the Effectiveness of Interlaminar and Bilateral Transforaminal Epidural Steroid Injections in Treatment of Patients With Lumbosacral Disc Herniation and Spinal Stenosis

The purpose of this study is to compare the effectiveness of interlaminar (IL) and bilateral transforaminal (TF) epidural steroid injections (ESIs) for pain reduction in patients with axial back pain resulting from herniated intervertebral disc (HIVD) and spinal stenosis (SS). Patients reporting axial back pain without radiation continuing over 3 months, which resulted from lumbosacral SS or HIVD were recruited and assigned to either the IL or TF technique group. The degree of pain and patient satisfaction were evaluated by the Numerical Rating Scale (NRS), the Patient Satisfaction Index (PSI), and the Roland 5-point pain score, which were administered at pretreatment, 2 weeks, 2 months, and 4 months after ESI. Both the TF and IL ESIs accomplished significant pain reduction in HIVD and SS from 2 weeks to 4 months after treatment. SS showed a more significant reduction in the Roland 5-point pain score and obtained more successful NRS results using the TF technique as compared with the IL technique. HIVD did not show any differences between the techniques. Bilateral TF epidural injection allowed the higher concentration of injectates to be delivered into ventral epidural space bilaterally. The IL approach can be more affected by tissue fibrosis, scarring, or hypertrophy, which is more prominently featured in SS than in HIVD; these prevent the injectate delivered via the posterior route from spreading to the ventral epidural space. Consequently, in patients with SS, bilateral TF produces better results than IL.

A 50-Year-Old Man With Chronic Low Back Pain

Mr S, a 50-year-old man, has long-standing low back pain. His pain began more than 20 years earlier with a lumbar disk herniation and has persisted despite diskectomy. He has undergone numerous treatments, but he remains disabled with ongoing pain. His treatment course is used to frame the epidemiology and pathophysiology underlying acute and chronic lumbosacral and radicular pain. The roles of neuropathic pain medications, chronic opioid therapy, physical therapy, spinal manipulation, and multidisciplinary pain treatment programs are reviewed. The indications for and outcomes associated with interventional pain treatments, including epidural steroid injection, facet blocks and radiofrequency treatment for facet-related pain, intradiskal electrothermal therapy, spinal cord stimulation, and intrathecal drug delivery, are discussed. Clinicians are given an evidence-based approach to using available treatment options for low back pain.

Brainstem Stroke Following Uncomplicated Cervical Epidural Steroid Injection

Cervical epidural steroid injection treatment of radicular pain has become a common procedure. To describe the clinical, radiologic, and autopsy findings of a 41-year-old patient treated with methylprednisolone acetate cervical epidural steroid injection, who developed a fatal hemorrhagic brainstem infarction and to discuss the possible mechanisms involved. Case report. Pain management center and tertiary care hospital. Immediately following a seemingly uncomplicated epidural steroid injection at C5-6, the patient developed progressive symptoms of extensive brainstem and thalamic infarction (documented by magnetic resonance imaging and autopsy) with hemorrhagic conversion and hydrocephalus. Hemorrhage within the adventitia of the left vertebral artery, but no dissection, was found at the C5 vertebral level at necropsy. This case report shows the possibility of serious intracranial pathology resulting from cervical epidural steroid injection despite use of fluoroscopic guidance. Vascular spasm distant to the site of injection is a possible mechanism.

Intratympanic Steroid Injection for Treatment of Idiopathic Sudden Hearing Loss

Intratympanic Steroid Injection for Treatment of Idiopathic Sudden Hearing Loss

Grey Scale and Power Doppler Sonographic Changes Induced by Intraarticular Steroid Injection Treatment

Grey Scale and Power Doppler Sonographic Changes Induced by Intraarticular Steroid Injection Treatment

Recent advances in endoscopic ultrasonography.

Endoscopic ultrasonography is recognized as an important tool in the diagnosis and staging of esophageal, gastric, colorectal, pancreatic, and biliary tumors. It also is a reliable method for the evaluation of submucosal tumors of the gastrointestinal tract, the differentiation between benign and malignant giant gastric folds, the evaluation of gastric ulcer healing, and the detection of common bile duct stones. The recent introduction of endoscopic ultrasonographic fine-needle aspiration provides for the cytologic and histologic diagnosis of gastrointestinal submucosal and extraluminal tumors and regional lymph nodes. This new technique may also be used for the intrasphincteric injection of botulinum toxin in the treatment of achalasia, for the steroid injection treatment of refractory esophageal strictures, for celiac nerve block, for pseudocyst drainage, and for drug delivery into pancreatic tumors. High-frequency thin ultrasonic probes can be used to make a more accurate diagnosis of superficial carcinomas of the gastrointestinal tract and for intraductal ultrasonography of the extrahepatic bile duct and pancreatic duct. In the future, three-dimensional imaging of gastrointestinal tumors will provide more accurate information regarding cancer extent. Endoscopic ultrasonography is a powerful tool which can be used in the diagnosis and treatment of a variety of gastrointestinal diseases.

CO2Laser Resurfacing and Skin Care for Asians

Laser resurfacing is a new and advanced rejuvenation method, and also an effective and safe modality to treat skin lesions and scars. We treated 727 patients with high power CO2 laser (Ultrapulse) for the last two and half years at Korea University Hospital. For rejuvenation we treated with one to three passes of 250 to 300 mj on the thin areas such as the eyelids and the mandibular border, and with two to five passes of 300 to 500 mj on the thick areas of forehead, cheek, and perioral area. After resurfacing, wrinkles were improved 1 to 2 degrees and age spots were removed. For depressed scars, such as those resulting from acne or small pox, we treated with even depth resurfacing combined with the laser punch out method. Hyperpigmentation is very common in Asians, with up to 80% affected, to varying degrees, so pre-and postlaser skin care is very important to control the postlaser hyperpigmentation. Postlaser hyperpigmentation was resolved within 2 to 4 weeks, so hyperpigmentation is not an obstacle. The skin care program containing Hydroquinone, Retinoic acid, and Hydrocortisone was started at least 2 weeks before laser resurfacing. Postlaser skin care was restarted as soon as possible if a patient could tolerate it with low percentage of Retinoic acid. Patients with severe melasma or hypersensitivity to bleaching or exfoliating agents are considered as contraindications to laser resurfacing. There were 9 cases of Herpes simplex and Candidiasis infection, but they were controlled with antifungal or antiviral drugs. There was no hypertrophic scar in rejuvenation cases, but in patients with scar treatment, focal hypertrophy was noted and controlled with early treatment of steroid injection. We have concluded that CO2 laser is a safe and effective resurfacing method for Asian patients.

A Preliminary Report on Treatment of Contact Granuloma With Steroid Injections

This preliminary report discusses the effects of intralesion local steroid injection for treatment of contact granulomas. Four men between the ages of 39 and 59 years and one woman age 33 years, who were diagnosed with contact granulomas and who failed previous management attempts, are discussed. Intralesion steroid injections of triamcinolone were completed in an otolaryngology outpatient clinic. Results showed that the size of contact granulomas was reduced with injection of the steroid in all five patients. Contact granuloma was completely eliminated in one patient. Furthermore, all patients were clinically asymptomatic 3 to 4 months post-injection, although only two of the five granulomas were totally eliminated at the time of long-term follow-up. Clinical improvement was confirmed by direct laryngoscopic evaluation of contact granuloma size 4 months following completion of the steroid injections. A speech-language pathologist's knowledge of this technique may prevent patients with granuloma from enduring protracted voice treatment that is historically less effective. The speech-language pathologist's responsibilities include determining patient candidacy for intralesion steroid injection, assisting the otolaryngologist with endoscopic interpretation of the lesion pre- and post-intervention, and tracking the clinical outcome of the procedure.

Treatment of trigger finger in patients with diabetes mellitus

We present a retrospective study of 54 diabetic patients with 121 trigger digits treated over a 3-year period by one to three injections of corticosteroid mixed with local anesthetic. As a group, diabetic patients responded less favorably to treatment by steroid injection (50% symptom resolution) when compared to reported outcomes of steroid injection treatment for stenosing tenosynovitis in the general population. Insulin-dependent diabetic patients have a higher incidence of multiple digit involvement (59% of patients) and of requiring surgical release for relief of symptoms (56% of digits) when compared to non-insulin-dependent diabetic patients (28% of patients with multiple digit involvement; 28% of digits requiring surgery).

Cortisone Injection With Anesthetic Additives for Radial Epicondylalgia (Tennis Elbow)

In a prospective, randomized, double-blind study of radial epicondylalgia (tennis elbow), 109 patients with an average symptom duration of 8 months were considered for treatment with a single 1-mL injection of the steroid triamcinolone combined with either lidocaine or bupivacaine. The patients received clinical examinations at regular intervals for 1 year, and followup included visual analog pain scale and questionnaires. The 2 groups were comparable and for many factors distributed completely evenly with respect to gender, age, symptom duration, side dominance, type of pain onset, earlier treatment, and occupational loading. The only difference between the groups receiving lidocaine or bupivacaine was found at 2 weeks, when the bupivacaine additive yielded a better outcome for patients who had not been treated in any way before, for those with a short history of epicondylalgia, or both. The steroid injection treatment, regardless of which local anesthetic was given, presented a typical pattern, with symptoms relieved quickly by 2 weeks and then deterioration for many patients at 3 months, indicating a tendency to recurrence. A considerable loss of patients to other treatments at the 1-year followup indicated an equivocal long-term result. Patients who had not been treated earlier in any way had a more favorable prognosis, as did those with a history of epicondylalgia to 3 months.

Transurethral resection combined with steroid injection in treatment of recurrent vesical neck contractures

Vesical neck contractures occur following 5 to 10 per cent of transurethral prostatectomies and an even smaller number of enucleative prostatectomies. Recurrences following both conservative and surgical treatment are common and present management problems to the urologist. Seven patients with recurrent vesical neck contractures were managed with reresection and steroid injection. One hundred per cent of patients responded to this although 1 patient required two procedures. The use of hydrocortisone sodium succinate (Solu-Cortef) versus triamcinolone acetonide (Kenalog) preparations are discussed.

Intratympanic injection of steroid for treatment of facial paralysis.

AbstractCorticosteroids administered systemically have been used with varying degrees of success in the treatment of idiopathic facial paralysis. There is reason to believe that this drug exerts a beneficial influence based on the work of numerous investigators. On the basis of existing dehiscences along the course of the facial nerve and exposure of the chorda tympani nerve, such abnormalities might well be sites of entrance for insult to these nerves; likewise, they might serve as portals for direct medication. Such medication, a corticosteroid, might thus be introduced intratympanically. Seven earlier cases were so treated with complete recovery in six cases and 75 percent recovery in the seventh. Three more cases are reported, all with good and prompt recovery. No untoward side effects were noted.