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Chapter-132 Epidural Steroid Injections

BOOK TITLE: Ramamurthy's Decision Making in Pain Management: An Algorithmic Approach

Author
1. V Graff
ISBN
9789386261458
DOI
10.5005/jp/books/14128_133
Edition
3/e
Publishing Year
2018
Pages
2
Author Affiliations
1. University of Pennsylvania Perelman, School of Medicine, Philadelphia, PA, USA
Chapter keywords
Epidural steroid injection, nerve root, chemical inflammation, bleeding, clotting disorder, anticoagulation, systemic infection, osteoporosis

Abstract

Epidural steroid injections are commonly indicated for radicular pain caused either by mass effect or chemical irritation of the nerve roots. Mass effect can result from intervertebral disk displacement, bone spurs, or stenosis. Chemical inflammation by substances such as cytokines and prostaglandins typically cause radicular pain by irritating nerve roots that stem from the spinal cord. Frequently, this type of pain is distributed in a specific dermatomal pattern, which can help localize what level the epidural injections should be administered. Bleeding or clotting disorders, anticoagulation, local and systemic infections, and patient refusal, are some of the common contraindications to epidural injections. Potential complications of epidural steroid injections include bleeding, infection, ischemia, osteoporosis or osteopenia secondary to steroid exposure, postdural puncture headaches, and arachnoiditis if the steroid is accidentally injected into the intrathecal space.

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