epidural glucocorticoid injection; epidural steroid injection (ESI)
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Indications
- treatment option after failure of more conservative measures
Benefit/risk
- epidural steroid injections for sciatica
- of no benefit for spinal stenosis[5]
Pharmacokinetics
- suppression of AM serum cortisol at 3 & 6 weeks[3]
Procedure
- injection of glucocorticoid into the epidural space within the spinal column
- generally a depot form (or suspension) is injected for sustained release
Complications
- common[4]
- uncommon[4]
- rare
- loss of vision, stroke, paralysis, death[2]
- adrenal suppression may persist for >= 3 weeks[3]
- high risk for infection after lumbar spine decompression surgery[6]
More general terms
More specific terms
- cervical/thoracic epidural glucocorticoid/anesthetic injection
- lumbosacral epidural glucocorticoid/anesthetic injection
References
- ↑ Chen B eMedicine (Medscape): Epidural Steroid Injections http://emedicine.medscape.com/article/325733-overview
- ↑ 2.0 2.1 FDA MedWatch. April 23, 2014 Epidural Corticosteroid Injection: Drug Safety Communication - Risk of Rare But Serious Neurologic Problems. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm394530.htm
FDA Drug Safety Communication: FDA requires label changes to warn of rare but serious neurologic problems after epidural corticosteroid injections for pain. http://www.fda.gov/downloads/Drugs/DrugSafety/UCM394286.pdf - ↑ 3.0 3.1 3.2 Friedly JL et al A Randomized Trial of Epidural Glucocorticoid Injections for Spinal Stenosis. N Engl J Med 2014; 371:11-21. July 3, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24988555 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1313265
Andersson GB Epidural Glucocorticoid Injections in Patients with Lumbar Spinal Stenosis. N Engl J Med 2014; 371:75-76July 3, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24988561 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMe1405475 - ↑ 4.0 4.1 4.2 4.3 The NNT: Epidural Steroid Injections for Pain and Disability Associated with Sciatica. http://www.thennt.com/nnt/epidural-steroids-for-sciatica/
Pinto RZ et al Epidural Corticosteroid Injections in the Management of Sciatica: A Systematic Review and Meta-analysis. Ann Intern Med. 13 November 2012 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23362516 <Internet> http://annals.org/article.aspx?articleid=1390546 - ↑ 5.0 5.1 5.2 Chou R, Hashimoto R, Friedly J et al Epidural Corticosteroid Injections for Radiculopathy and Spinal Stenosis: A Systematic Review and Meta-analysis. Ann Intern Med. 2015 Sep 1; 163:373 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26302454 <Internet> http://annals.org/article.aspx?articleid=2430207
- ↑ 6.0 6.1 Lowry F Epidural Steroid Injections Linked to High Risk for Post-Op Infection. Medscape. March 30, 2022 https://www.medscape.com/viewarticle/971241