| 词条 | Epidural steroid injection |
| 释义 |
| name = Epidural steroid injection | synonym = | image = Blausen 0354 EpiduralSteroidInjection.png | caption = Steroids are injected into the cerebrospinal fluid in the canal surrounding the spine. Nerves branch out from the spine. The nerve roots, which may be compressed, are at the base of the nerves. | alt = | pronounce = | specialty = neurology | synonyms = | ICD10 = | ICD9 = | ICD9unlinked = | CPT = | MeshID = | LOINC = | other_codes = | MedlinePlus = | eMedicine = }}Epidural steroid injection (ESI) is a technique in which corticosteroids and a local anesthetic are injected into the epidural space around the spinal cord in an effort to improve spinal stenosis, spinal disc herniation, or both. It is of unclear benefit with a rare rate of major side effects.[1][2] Medical usesEpidural steroid injection for sciatica and spinal stenosis is of unclear effect.[1] The evidence to support use in the cervical spine is not very good.[2] When medical imaging is not used to determine the proper spot for injection, ESI benefits appear to be of short term benefit when used in sciatica.[3] It is unclear if ESI is useful for chronic pain after spinal surgery.[4] Side effectsMajor side effects are rare.[2] These include loss of vision, stroke, paralysis, or death when the corticosteroids are infected, as in a 2012 meningitis outbreak.[5][6] Another study found an increased odds of developing epidural lipomatosis, independent of BMI or other factors.[7] TechniqueElective spinal injections should be performed with imaging guidance, such as fluoroscopy or the use of a radiocontrast agent, unless that guidance is contraindicated.[8] Imaging guidance ensures the correct placement of the needle and maximizes the physician's ability to make an accurate diagnosis and administer effective therapy.[8] Without imaging, the risk increases for the injection to be incorrectly placed, and this would in turn lower the therapy's efficacy and increase subsequent risk of need for more treatment.[8] While traditional techniques without image guidance, also known as blind injections, can assure a degree of accuracy using anatomical landmarks, it has been shown in studies that image guidance provides much more reliable localization and accuracy in comparison. References{{Portal|Medicine}}1. ^1 {{cite journal |last1 = Shaughnessy |first1 = AF |title = Epidural Steroid Not Better Than Placebo Injection for Sciatica and Spinal Stenosis Pain and Function. |journal = American Family Physician |date = 15 February 2016 |volume = 93 |issue = 4 |pages = 315–6 |pmid = 26926820 }} 2. ^{{cite journal |last1 = Cohen |first1 = SP |last2 = Hooten |first2 = WM |title = Advances in the diagnosis and management of neck pain |journal = BMJ (Clinical research ed.) |date = 14 August 2017 |volume = 358 |pages = j3221 |pmid = 28807894 |doi = 10.1136/bmj.j3221 }} 3. ^{{cite journal |last1 = Vorobeychik |first1 = Y |last2 = Sharma |first2 = A |last3 = Smith |first3 = CC |last4 = Miller |first4 = DC |last5 = Stojanovic |first5 = MP |last6 = Lobel |first6 = SM |last7 = Valley |first7 = MA |last8 = Duszynski |first8 = B |last9 = Kennedy |first9 = DJ|last10=Standards Division of the Spine Intervention|first10=Society. |title = The Effectiveness and Risks of Non-Image-Guided Lumbar Interlaminar Epidural Steroid Injections: A Systematic Review with Comprehensive Analysis of the Published Data. |journal = Pain medicine (Malden, Mass.) |date = December 2016 |volume = 17 |issue = 12 |pages = 2185–2202 |doi = 10.1093/pm/pnw091 |pmid = 28025354 }} 4. ^{{cite journal |last1 = Wylde |first1 = V |last2 = Dennis |first2 = J |last3 = Beswick |first3 = AD |last4 = Bruce |first4 = J |last5 = Eccleston |first5 = C |last6 = Howells |first6 = N |last7 = Peters |first7 = TJ |last8 = Gooberman-Hill |first8 = R |title = Systematic review of management of chronic pain after surgery. |journal = The British Journal of Surgery |date = September 2017 |volume = 104 |issue = 10 |pages = 1293–1306 |doi = 10.1002/bjs.10601 |pmid = 28681962 |pmc=5599964}} 5. ^1 2 {{cite journal |last1 = Schneider |first1 = B |last2 = Zheng |first2 = P |last3 = Mattie |first3 = R |last4 = Kennedy |first4 = DJ |title = Safety of epidural steroid injections. |journal = Expert Opinion on Drug Safety |date = August 2016 |volume = 15 |issue = 8 |pages = 1031–9 |doi = 10.1080/14740338.2016.1184246 |pmid = 27148630 }} 6. ^{{cite journal |last1 = Kauffman |first1 = CA |last2 = Malani |first2 = AN |title = Fungal Infections Associated with Contaminated Steroid Injections |journal = Microbiology spectrum |date = April 2016 |volume = 4 |issue = 2 |pages = 359–374 |doi = 10.1128/microbiolspec.EI10-0005-2015 |pmid = 27227303 |isbn = 978-1-55581-944-6 }} 7. ^{{cite journal |last1 = Jaimes |first1 = Rafael |last2 = Rocco |first2 = Angelo |title = Multiple epidural steroid injections and body mass index linked with occurrence of epidural lipomatosis: a case series |journal = BMC Anesthesiology |date = August 2014 |volume = 14 |issue = 70 |doi =10.1186/1471-2253-14-70 |pmid =25183952 |url=https://doi.org/10.1186/1471-2253-14-70 |pmc=4145583}} 8. ^1 2 {{Citation |author1 = North American Spine Society |author1-link = North American Spine Society |date = February 2013 |title = Five Things Physicians and Patients Should Question |publisher = North American Spine Society |work = Choosing Wisely: an initiative of the ABIM Foundation |page = |url = http://www.choosingwisely.org/doctor-patient-lists/north-american-spine-society/ |accessdate = 25 March 2013 }}, which cites* {{cite journal |title = Diagnosis and treatment of degenerative lumbar spinal stenosis |date = 2011 |page = 104 |url = http://www.guideline.gov/content.aspx?id=34839 |author = North American Spine Society |authorlink = North American Spine Society |publisher = Agency for Healthcare Research and Quality |location = Burr Ridge, Illinois |journal = — |access-date = 25 March 2014 |archive-url = https://web.archive.org/web/20140325190820/http://www.guideline.gov/content.aspx?id=34839 |archive-date = 25 March 2014 |dead-url = yes |df = dmy-all }} 4 : Analgesics|Bones of the vertebral column|Medical treatments|Neurology procedures |
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