신경근 조영 증강 유무에 따른 경추간공 경막외 스테로이드 주사의 효과

도성진,조윤우,심대섭,조희경,김한선,장성호,안상호 대한재활의학회 2010 Annals of Rehabilitation Medicine Vol.34 No.2

Objective: To determine the efficacy of transforaminal epidural steroid injections according to nerve root enhancement in lumbar disc herniations. Method: Twenty seven patients who had extruded or seques tered lumbar disc herniations on enhanced MR imaging were investigated: fifteen patients with corresponding nerve root enhancement (enhanced group), and twelve patients without enhancement (non-enhanced group). All patients received transforaminal epidural steroid injection. Clinical outcomes were measured by visual analogue scale (VAS) for back and radicular pain, Oswestry disability index (ODI) before treatment and one month after injection. Results: The averages of VAS for lower extremity and back pain in both groups one month after injection significantly reduced compared to that of pretreatment, respectively (p<0.001). The amount of decrease in pain in enhanced group was larger than that of non-enhanced group (p<0.05). The averages of ODI in both group one month after injection significantly reduced compared to that of pretreatment (p<0.0001), however, there was no difference between the two groups. Conclusion: The nerve root enhancement on contrast-enhanced MR imaging indicates the presence of severe inflammatory reaction of nerve root, which means well-responsiveness to anti-inflammatory treatment such as transforaminal epidural steroid injection, even if patients’ symptom is very severe. (J Korean Acad Rehab Med 2010; 34: 204-208) Objective: To determine the efficacy of transforaminal epidural steroid injections according to nerve root enhancement in lumbar disc herniations. Method: Twenty seven patients who had extruded or seques tered lumbar disc herniations on enhanced MR imaging were investigated: fifteen patients with corresponding nerve root enhancement (enhanced group), and twelve patients without enhancement (non-enhanced group). All patients received transforaminal epidural steroid injection. Clinical outcomes were measured by visual analogue scale (VAS) for back and radicular pain, Oswestry disability index (ODI) before treatment and one month after injection. Results: The averages of VAS for lower extremity and back pain in both groups one month after injection significantly reduced compared to that of pretreatment, respectively (p<0.001). The amount of decrease in pain in enhanced group was larger than that of non-enhanced group (p<0.05). The averages of ODI in both group one month after injection significantly reduced compared to that of pretreatment (p<0.0001), however, there was no difference between the two groups. Conclusion: The nerve root enhancement on contrast-enhanced MR imaging indicates the presence of severe inflammatory reaction of nerve root, which means well-responsiveness to anti-inflammatory treatment such as transforaminal epidural steroid injection, even if patients’ symptom is very severe. (J Korean Acad Rehab Med 2010; 34: 204-208)

Original Articles : Analysis of Influencing Factors to Depth of Epidural Space for Lumbar Transforaminal Epidural Block in Korean

( Sung Sick Shin ),( Lee Kyoung Kim ),( Jung Ryul Kim ),( In Ji Kim ),( Bac Ne Kim ),( Gan Tac Hwang ) 대한통증학회 2011 The Korean Journal of Pain Vol.24 No.4

Background: Transforaminal epidural steroid injection is one of the effective treatments in managing radicular pain. There have been some prospective studies on the depth to the epidural space with the transforaminal approach. However, there have been no studies about the depth in Asians, especially Koreans. This study was carried out in order to evaluate the depth to the epidural space and the oblique angle and factors that influence the depth to the epidural space during lumbar transforaminal epidural injection. Methods: A total of 248 patients undergoing fluoroscopically guided transforaminal epidural steroid injections were evaluated. At the L3-4, L4-5, L5-S1, and S1 levels, we measured the oblique angle and depth to the epidural space. Results: Needle depth was positively associated with body mass index (correlation coefficient 0.52, P = 0.004). The median depths (in centimeters) to the epidural space were 6.13 cm, 6.42 cm, and 7.13 cm for 50-60 kg, 60-70 kg, and 70-80 kg groups, respectively, at L5-S1. Age and height were not significantly associated with the needle depth. Conclusions: There is a positive association between the BMI (and weight) and transforaminal epidural depth but not with age, sex, and height.

경막외 주사 후 발생한 경막외 농양과 척추 골수염-증례보고-

이주강,임윤명,임오경,배근환,김성환,이광래,최충환,정점순 대한재활의학회 2008 Annals of Rehabilitation Medicine Vol.32 No.3

Epidural abscess and vertebral osteomyelitis induced by epidural injection is rare but one of the most serious complications. A 58-year old woman complained of aggrevating radicular pain to bilteral lower legs, tenderness on coccygeal area and claudication, after epidural injection for management of intractable sciatica. MRI and ultrasound revealed epidural abscess compressing dural sac at the level of L5-S1 vertebral body, sacrococcygeal abscess, and later S5- 1stcoccyx osteomyelitis. We report epidural abscess and vertebral osteomyelitis induced by caudal epidural injection.

요통환자에서 경막외 주사 효과에 대한 임상적 분석

박영재,김미정,이상건 大韓再活醫學會 1998 Annals of Rehabilitation Medicine Vol.22 No.2

요추 경막외 스테로이드 주사후 발생한 섬유성 종괴 : 증례 보고 A Case Report

김학선,석경수,김남현,김기덕,이환모 대한척추외과학회 1999 대한척추외과학회지 Vol.6 No.3

요통 및 방사통 환자에서 경막외 스테로이드와 국소 마취제 주사는 진통 및 소염 작용을 목적으로 사용된다. 경막외 또는 뇌척수액내 몰핀 주입후 발생한 육아종이나 섬유성 종괴에 의해 척수 압박 증상이 나타난 경우들이 보고된 바 있으며 스테로이드의 경막외 주사후 발생한 지주막염에 대한 보고도 있다. 그러나 스테로이드 및 국소 마취제 주사와 관련된 신경근 압박에 대한 보고는 아직 없다. 저자들은 요추간판 탈출증 환자에서 스테로이드와 국소 마취제 주사후 발생한 섬유성 종괴로 인한 신경근 압박 증상을 경험하였기에 요추부 경막외 스테로이드 및 국소 마취제 주사 치료전과 치료후의 방사선 소견 및 임상 경과를 보고한다. The use of epidural injection of local anesthetics with steroid for the treatment of back pain and sciatica is a widely used procedure. There have been several reports about spinal cord compression by granuloma or fibrous mass related to intrathecal or epidural morphine injection. there have been also some reports about arachnoiditis after epidural injection of steroid. However, there have been no reports regarding dural sac or nerve root compression by fibrous mass after epidural steroid injections. We would report a case of dural sac and nerve root compression secondary to the formation of fibrous mass in the lumbar epidural space after epidural steroid and local anesthetic jijections. In this case, the characteristic radiologic findings before and after epidural injection therapy and clinical progress were documented.

Epidural hematoma treated by aspiration after transforaminal epidural steroid injection - A case report -

Kim Go Eun,Hong Sung Jun,Kang Sang Soo,Ki Ho Joon,Park Jae Hyun 대한마취통증의학회 2021 Anesthesia and pain medicine Vol.16 No.2

Background: Spinal epidural hematoma is rare condition that can rapidly develop into severe neurologic deficits. The pathophysiology of this development remains unclear. There are several case reports of emergency hematoma evacuations after epidural steroid injection. Case: We report on two patients who developed acute, large amounts of epidural hematoma without neurological deficits after transforaminal epidural steroid injection. After fluoroscopy guided aspiration for epidural hematoma was performed, neurological defects did not progress and the hematoma was shown to be absorbed on magnetic resonance imaging. Conclusions: These reports are believed to be the first of treating epidural hematoma occurring after transforaminal epidural steroid injection through non-surgical hematoma aspiration. If large amounts of epidural hematoma are not causing neurological issues, it can be aspirated until it is absorbed.

Effect of epidural corticosteroid injection on magnetic resonance imaging findings

( Min Soo Kim ),( Tae Yoon Jeong ),( Yu Seon Cheong ),( Young Wook Jeon ),( So Young Lim ),( Seong Sik Kang ),( In Nam Kim ),( Tsong Bin Chang ),( Hyun Ho Seong ),( Byeong Mun Hwang ) 대한통증학회 2017 The Korean Journal of Pain Vol.30 No.4

Background: Magnetic resonance imaging (MRI) of the spine is the preferred diagnostic tool for pathologic conditions affecting the spine. However, in patients receiving epidural corticosteroid injection (ESI) for treatment of spinal diseases, there is a possibility of misreading of MR images because of air or fluid in the epidural space after the injection. Therefore, we defined the characteristics of abnormal changes in MRI findings following an ESI in patients with low back pain. Methods: We reviewed the medical records of 133 patients who underwent MRI of the lumbar spine within 7 days after ESI between 2006 and 2015.All patients were administered an ESI using a 22-gauge Tuohy needle at the lumbar spine through the interlaminar approach. The epidural space was identified by the loss of resistance technique with air. Results: The incidences of abnormal changes in MRI findings because of ESI were 54%, 31%, and 25% in patients who underwent MRI at approximately 24 h, and 2 and 3 days after ESI, respectively. Abnormal MRI findings included epidural air or fluid, needle tracks, and soft tissue changes. Epidural air, the most frequent abnormal finding (82%), was observed in 41% of patients who underwent MRI within 3 days after injection. Abnormal findings due to an ESI were not observed in MR images acquired 4 days after ESI or later. Conclusions: Pain physicians should consider the possibility of abnormal findings in MR images acquired after epidural injection using the interlaminar approach and the loss of resistance technique with air at the lumbar spine. (Korean J Pain 2017; 30: 281-6)

A Comparison of Two Techniques for Ultrasound-guided Caudal Injection: The Influence of the Depth of the Inserted Needle on Caudal Block

( A Ram Doo ),( Jin Wan Kim ),( Ji Hye Lee ),( Young Jin Han ),( Ji Seon Son ) 대한통증학회 2015 The Korean Journal of Pain Vol.28 No.2

Background: Caudal epidural injections have been commonly performed in patients with low back pain and radiculopathy. Although caudal injection has generally been accepted as a safe procedure, serious complications such as inadvertent intravascular injection and dural puncture can occur. The present prospective study was designed to investigate the influence of the depth of the inserted needle on the success rate of caudal epidural blocks. Methods: A total of 49 adults scheduled to receive caudal epidural injections were randomly divided into 2 groups: Group 1 to receive the caudal injection through a conventional method, i.e., caudal injection after advancement of the needle 1 cm into the sacral canal (n = 25), and Group 2 to receive the injection through a new method, i.e., injection right after penetrating the sacrococcygeal ligament (n = 24). Ultrasound was used to identify the sacral hiatus and to achieve accurate needle placement according to the allocated groups. Contrast dyed fluoroscopy was obtained to evaluate the epidural spread of injected materials and to monitor the possible complications. Results: The success rates of the caudal injections were 68.0% in Group 1 and 95.8% in Group 2 (P = 0.023). The incidences of intravascular injections were 24.0% in Group 1 and 0% in Group 2 (P = 0.022). No intrathecal injection was found in either of the two groups. Conclusions: The new caudal epidural injection technique tested in this study is a reliable alternative, with a higher success rate and lower risk of accidental intravascular injection than the conventional technique. (Korean J Pain 2015; 28: 122-128)

Analysis of Influencing Factors to Depth of Epidural Space for Lumbar Transforaminal Epidural Block in Korean

Kim, Lee-Kyoung,Kim, Jung-Ryul,Shin, Sung-Sick,Kim, In-Ji,Kim, Bac-Ne,Hwang, Gan-Tac The Korean Pain Society 2011 The Korean Journal of Pain Vol.24 No.4

Background: Transforaminal epidural steroid injection is one of the effective treatments in managing radicular pain. There have been some prospective studies on the depth to the epidural space with the transforaminal approach. However, there have been no studies about the depth in Asians, especially Koreans. This study was carried out in order to evaluate the depth to the epidural space and the oblique angle and factors that influence the depth to the epidural space during lumbar transforaminal epidural injection. Methods: A total of 248 patients undergoing fluoroscopically guided transforaminal epidural steroid injections were evaluated. At the L3-4, L4-5, L5-S1, and S1 levels, we measured the oblique angle and depth to the epidural space. Results: Needle depth was positively associated with body mass index (correlation coefficient 0.52, P = 0.004). The median depths (in centimeters) to the epidural space were 6.13 cm, 6.42 cm, and 7.13 cm for 50-60 kg, 60-70 kg, and 70-80 kg groups, respectively, at L5-S1. Age and height were not significantly associated with the needle depth. Conclusions: There is a positive association between the BMI (and weight) and transforaminal epidural depth but not with age, sex, and height.

Unintentional lumbar facet joint injection guided by fluoroscopy during interlaminar epidural steroid injection: a retrospective analysis

( Min Jae Kim ),( Yun Suk Choi ),( Hae Jin Suh ),( You Jin Kim ),( Byeong Jin Noh ) 대한통증학회 2018 The Korean Journal of Pain Vol.31 No.2

Background: An epidural steroid injection (ESI) is a commonly administered procedure in pain clinics. An unintentional lumbar facet joint injection during interlaminar ESI was reported in a previous study, but there has not been much research on the characteristics of an unintentional lumbar facet joint injection. This study illustrated the imaging features of an unintentional lumbar facet joint injection during an interlaminar ESI and analyzed characteristics of patients who underwent this injection. Methods: From December 2015 to May 2017, we performed 662 lumbar ESIs and we identified 24 cases (21 patients) that underwent a lumbar facet joint injection. We gathered data contrast pattern, needle approach levels and directions, injected facet joint levels and directions, presence of lumbar spine disease as seen on magnetic resonance images (MRI), and histories of lumbar spine surgeries. Results: The contrast pattern in the facet joint has a sigmoid or ovoid contrast pattern confined to the vicinity of the facet joint. The incidence of unintentional lumbar facet joint injection was 3.6%. The mean age was 68.47 years. Among these 21 patients, 14 (66.7%) were injected in the facet joint ipsilaterally to the needle approach. Among the 20 patients who received MRI, all (100%) had central stenosis and 15 patients (75%) had severe stenosis. Conclusions: When the operator performs an interlaminar ESI on patients with central spinal stenosis, the contrast pattern on the fluoroscopy during interlaminar ESI should be carefully examined to distinguish between the epidural space and facet joint. (Korean J Pain 2018; 31: 87-92)