Difference between revisions of "SPINE INJECTION-CORTICOSTEROIDS"
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===== [[Summary Article|'''SUMMARY''']] ===== | ===== [[Summary Article|'''SUMMARY''']] ===== | ||
1. A single epidural steroid injection (ESI) can cause adrenal suppression and | 1. A single epidural steroid injection (ESI) can cause adrenal suppression and hypothalamic-pituitary-adrenal axis imbalances for 1-5 weeks; complete suppression is limited to 4-7 days.136 | ||
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<br/>2. An ESI precipitates more prolonged suppression than intra-articular injection.209 | <br/>2. An ESI precipitates more prolonged suppression than intra-articular injection.209 | ||
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<br/>3. Many physicians advise | <br/>3. Many physicians advise no more than 3 ESIs per year or a 6-mth limit of 5 mg/kg of body weight.182 | ||
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<br/>4. After an ESI, diabetics can have elevated BSL during the first 4-7 days post-injection; poorer the diabetic control, the worse the hyperglycaemia; risk of ketoacidosis if severe. | <br/>4. After an ESI, diabetics can have elevated BSL during the first 4-7 days post-injection; poorer the diabetic control, the worse the hyperglycaemia; risk of ketoacidosis if severe. | ||
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<br/>5. Any local infection at the site of proposed injection is a contraindication, even when glucocorticoids are not being administered. | <br/>5. Any local infection at the site of proposed injection is a contraindication, even when glucocorticoids are not being administered. | ||
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<br/>6. Other effects: HTN, risk of new infections, reactivation of latent herpes, potentiate the | <br/>6. Other effects: HTN, risk of new infections, reactivation of latent herpes, potentiate the risk of GIT bleeding, especially with NSAIDs. | ||
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<br/>7. Accidental IA injection of particulates can lead to spinal cord infarction; cervical transforaminal | <br/>7. Accidental IA injection of particulates can lead to spinal cord infarction; cervical transforaminal epidural approach with particulate corticosteroid has been associated with serious complications. | ||
Latest revision as of 09:55, 25 July 2023
SUMMARY
1. A single epidural steroid injection (ESI) can cause adrenal suppression and hypothalamic-pituitary-adrenal axis imbalances for 1-5 weeks; complete suppression is limited to 4-7 days.136
2. An ESI precipitates more prolonged suppression than intra-articular injection.209
3. Many physicians advise no more than 3 ESIs per year or a 6-mth limit of 5 mg/kg of body weight.182
4. After an ESI, diabetics can have elevated BSL during the first 4-7 days post-injection; poorer the diabetic control, the worse the hyperglycaemia; risk of ketoacidosis if severe.
5. Any local infection at the site of proposed injection is a contraindication, even when glucocorticoids are not being administered.
6. Other effects: HTN, risk of new infections, reactivation of latent herpes, potentiate the risk of GIT bleeding, especially with NSAIDs.
7. Accidental IA injection of particulates can lead to spinal cord infarction; cervical transforaminal epidural approach with particulate corticosteroid has been associated with serious complications.
Reference(s)
Furman, Michael B., and Leland Berkwits. Atlas of Image-Guided Spinal Procedures. Elsevier, Inc, 2017.
Horowitz AL. MRI Physics for Physicians. Springer Science & Business Media. (1989) ISBN:1468403338.
Mangrum W, Christianson K, Duncan S et-al. Duke Review of MRI Principles. Mosby. (2012) ISBN:1455700843.
