Epidural steroids for back and leg pain: Mechanism of action and efficacy

Cleveland Clinic Journal of Medicine

Volumn 71, Issue 12, 2004, Pages 961-970

  McLain, Robert F ^a   Kapural, Leonardo ^a   Mekhail, Nagy A ^a  

^a LERNER RESEARCH INSTITUTE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

GLUCOCORTICOID; LOCAL ANESTHETIC AGENT; METHYLPREDNISOLONE; NONSTEROID ANTIINFLAMMATORY AGENT; PHOSPHOLIPASE A2; PLACEBO; STEROID; TRIAMCINOLONE;

ANTIINFLAMMATORY ACTIVITY; ARACHNOIDITIS; BACKACHE; CLINICAL TRIAL; DECOMPRESSION SURGERY; DEMOGRAPHY; DRUG CONTRAINDICATION; DRUG COST; DRUG EFFICACY; DRUG HYPERSENSITIVITY; DRUG INDICATION; DRUG INDUCED DISEASE; DRUG INDUCED HEADACHE; ENZYME INHIBITION; FLUID RETENTION; FLUOROSCOPY; HEMATOMA; HIGH RISK PATIENT; HUMAN; HYPERGLYCEMIA; HYPERTENSION; HYPOTHALAMUS HYPOPHYSIS SYSTEM; INFECTION; INTERVERTEBRAL DISK HERNIA; JOINT FUNCTION; LEG MOVEMENT; LEG PAIN; NERVE COMPRESSION; NEURITIS; NEUROTOXICITY; PATHOPHYSIOLOGY; PRACTICE GUIDELINE; RADICULAR PAIN; REVIEW; RISK ASSESSMENT; RISK BENEFIT ANALYSIS; SIDE EFFECT; SOCIOECONOMICS; SYMPTOMATOLOGY; TREATMENT FAILURE; TREATMENT INDICATION; TREATMENT OUTCOME; VERTEBRAL CANAL STENOSIS; DISEASE COURSE; EPIDURAL DRUG ADMINISTRATION; INFLAMMATION; ISCHIALGIA; RADICULOPATHY;

BACK PAIN; DISEASE PROGRESSION; GLUCOCORTICOIDS; HUMANS; INFLAMMATION; INJECTIONS, EPIDURAL; RADICULOPATHY; SCIATICA;

EID: 13844267065     PISSN: 08911150     EISSN: None     Source Type: Journal    
DOI: 10.3949/ccjm.71.12.961     Document Type: Review

References (52)

1. Lindblom K, Rexed B. Spinal nerve injury in dorsolateral protrusions of lumbar disks. J Neurosurg 1948; 5:413-432.
2. McRae DL. Asymptomatic intervertebral disc protrusions. Acta Radiol 1956; 46:9-27.
3. Hitselberger WE, Witten RM. Abnormal myelograms in asymptomatic patients. J Neurosurg 1968; 28:204-206.
4. Boden SD, Davis DO, Dina TS, Patronas NJ, Weisel S. Abnormal magnetic resonance scans of the lumbar spine in asymptomatic subjects. J Bone Joint Surg 1990; 72A:403-408.
5. Weber H. Lumbar disc herniation. A controlled prospective study with ten years observation. Spine 1980; 8:131-140.
6. Howe JF, Loeser JD, Calvin WH. Mechanosensitivity of dorsal root ganglia and chronically injured axons: a physiological basis for the radicular pain of nerve root compression. Pain 1977; 3:25-41.
7. Murphy RW. Nerve roots and spinal nerves in degenerative disc disease. Clin Orthop 1977; 129:46-60.
8. Lindahl O, Rexed B. Histological changes in spinal nerve roots of operated cases of sciatica. Acta Orthop Scand 1950; 20:215-225.
9. Berg A. Clinical and myelographic studies of conservatively treated cases of lumbar intervertebral disc protrusion. Acta Chir Scand 1953; 104:124-129.
10. Green LN. Dexamethasone in the management of symptoms due to herniated lumbar disc. J Neurol Neurosurg Psychiatry 1975; 38:1211-1217.
11. Saal JS, Sibley R, Dobrow R, Reynolds J, Saal JA, White AH. Cellular response to lumbar disc herniations: an immunohistochemical study. Proceedings of the International Society for the Study of the Lumbar Spine, Boston, Mass. 1990.
12. Pruzansky W, Vadas P. Phospholipase A2, a mediator between proximal and distal effectors of inflammation. Immunol Today 1991; 12:143-146.
13. Varani J, Ginsburg I, Schuger L. Endothelial cell killing by neutrophils: synergistic interaction of oxygen products and proteases. Am J Pathol 1989; 135:435-438.
14. Rappolee DA, Werb Z. Secretory products of phagocytes. Curr Opin Immunol 1988; 1:47-55.
15. Saal JS, Franson RC, Dobrow R, Saal JA, White AH, Goldthwaite N. High levels of inflammatory phospholipase A2 activity in lumbar disc herniations. Spine 1990; 15:674-678.
16. Weinstein JN, Claverie W, Gibson S. The pain of discography. Spine 1988; 13:1344-1348.
17. Bogduk N. The innervation of the lumbar spine. Spine 1983; 8:286-293.
18. Yoshizawa H, O'Brien JP, Smith WT, Trumper M. The neuropathology of the intervertebral disc removed for low back pain. J Pathol 1980; 132:95-104.
19. Ashton IK, Roberts S, Jaffray DC, Polak JM, Eisenstein SM. Neuropeptides in the human intervertebral disc. J Orthop Research 1994; 12:186-192.
20. DiRosa M, Calignano A, Carnuccio R, Ialenti A, Sautebin L. Multiple control of inflammation by glucocorticoids. Agents Action 1985; 17:284-289.
21. Cronstein BN, Kimmel SC, Levin RI, Martiniuk F, Weissman G. A mechanism for the anti-inflammatory effects of corticosteroids: the glucocorticoid receptor regulates leukocyte adhesion to endothelial cells and expression of endothelial-leukocyte adhesion molecule-1 and intercellular adhesion molecule-1. Proc Natl Acad Sci USA 1992; 89:9991-9995.
22. Viner N. Intractable sciatica. The sacral epidural injection - an effective method of giving relief. Can Med Assoc J 1925; 15:630-634.
23. Brown JH. Pressure caudal anaesthesia and back manipulation. Northwest Med (Seattle) 1960; 59:905-909.
24. Goebert HW, Jallo SJ, Gardner WJ, Wasmuth CE, Bitte EM. Sciatica: treatment with epidural injections of procaine and hydrocortisone. Cleve Clin Q 1960; 27:191-197.
25. Swerdlow M, Sayle-Creer W. A study of extradural medication in the relief of the lumbosciatic syndrome. Anaesthesia 1970; 25:341-345.
26. Nelson DA, Vates TS, Thomas RB. Complications from intrathecal steroid therapy in patients with multiple sclerosis. Acta Neurol Scand 1973; 49:176-188.
27. Benzon HT. Epidural injections for low back pain and lumbosacral radiculopathy. Pain 1986; 24:277-295.
28. Bowman SJ, Wedderburn L, Whaley A, Grahame R, Newman S. Outcome assessment after epidural corticosteroid injection for low back pain and sciatica. Spine 1993; 18:1345-1350.
29. Green PWB, Burke AJ, Weiss CA, Langan P. The role of epidural cortisone injection in the treatment of discogenic low back pain. Clin Orthop 1980; 153:121-125.
30. Harley C. Extradural corticosteroid infiltration. A follow-up study of 50 cases. Ann Phys Med 1967; 9:22-28.
31. Kelman H. Epidural injection therapy for sciatic pain. Am J Surg 1944; 64:183-190.
32. Ito R. The treatment of low back pain and sciatica with epidural corticosteroids injection and its pathophysiological basis. J Japan Orthop Assoc 1971; 45:769-777.
33. Andersen KH, Mosdal C. Epidural application of corticosteroids in low back pain and sciatica. Acta Neurochir 1987; 87:52-53.
34. Berman AT, Garbarino JL, Fischer SM, et al. The effects of epidural injection of local anesthetics and corticosteroids on patients with lumbosciatic pain. Clin Orthop 1988; 188:144-151.
35. Power RA, Taylor GJ, Fyfe IS. Lumbar epidural injection of steroid in acute prolapsed intervertebral discs. Spine 1992; 17:453-455.
36. Dilke TFW, Burry HC, Grahame R. Extradural corticosteroid injection in management of lumbar nerve root compression. Br Med J 1973; 2:635-637.
37. Snoek W, Weber H, Jorgensen B. Double blind evaluation of extradural methylprednisolone for herniated lumbar discs. Acta Orthop Scand 1977; 48:635-641.
38. Ridley MG, Kingsley GH, Gibson T, Grahame R. Outpatient lumbar epidural corticosteroid injection in the management of sciatica. Br J Rheumatol 1988; 27:295-299.
39. Klenerman L, Greenwood R, Davenport HT, White DC, Peskett S. Lumbar epidural injections in the treatment of sciatica. Br J Rheumatol 1984; 23:35-38.
40. Bush K, Hillier S. A controlled study of caudal epidural injections of triamcinolone plus procaine for the management of intractable sciatica. Spine 1991; 16:572-575.
41. Watts RW. Silagy CS. A meta-analysis on the efficacy of epidural corticosteroids in the treatment of sciatica. Anaesth Intens Care 1995; 23:564-569.
42. Carette S, Leclaire R, Marcoux S, et al. Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus. N Engl J Med 1997; 336:1634-1640.
43. Hopwood MB, Abram SE. Factors associated with failure of lumbar epidural steroids. Reg Anaesth 1993; 18:238-243.
44. Jamison RN, VadeBoncouer T, Ferrante FM. Low back pain patients unresponsive to an epidural steroid injection: identifying predictive factors. Clin J Pain 1991; 7:311-317.
45. White AH, Derby R, Wynne G. Epidural injections for diagnosis and treatment of low back pain. Spine 1980; 5:78-86.
46. Renfrew DL, Moore TE, Kathol MH, el-Khoury GY, Lemke JH, Walker CW. Correct placement of epidural steroid injections: fluoroscopic guidance and contrast administration. Am J Neuroradiol 1991; 12:1003-1007.
47. Abram SE. Treatment of lumbosacral radiculopathy with epidural steroids. Anesthesiology 1999; 91:1937-1941.
48. White AH. Injection techniques for the diagnosis and treatment of low back pain. Orthop Clin North Am 1983; 14:553-567.
49. Brown FW. Management of diskogenic pain using epidural and intrathecal steroids. Clin Orthop 1977; 129:72-78.
50. Botwin T, Rittenberg B. Fluoroscopically guided lumbar transforaminal epidural steroid injections in degenerative lumbar stenosis: an outcome study. Am J Phys Med Rehabil 2002; 81:898-895.
51. Vad VB, Bhat AL, Lutz GE, et al. Transforaminal epidural steroid injections in lumbosacral radiculopathy: a prospective randomized study. Spine 2002; 27:11-16.
52. Lutz GE, Vad VB, Wisneski RJ. Fluoroscopic transforaminal lumbar epidural steroids: an outcome study. Arch Phys Med Rehabil 1998; 79:1362-1366.