ACR–ASNR–ASSR–SIR–SNIS PRACTICE PARAMETER FOR THE PERFORMANCE OF IMAGE-GUIDED EPIDURAL STEROID INJECTION (NEW)

PREAMBLE

INTRODUCTION

II.

DEFINITIONS

III.

OVERVIEW

IV.

INDICATIONS AND CONTRAINDICATIONS

IV.

INDICATIONS AND CONTRAINDICATIONS

Technical Requirements

Guidance

IV.

INDICATIONS AND CONTRAINDICATIONS

Physician

IV.

INDICATIONS AND CONTRAINDICATIONS

Physician

Technique

IV.

INDICATIONS AND CONTRAINDICATIONS

Qualified Medical Physicist

IV.

INDICATIONS AND CONTRAINDICATIONS

Qualified Medical Physicist

Facility

IV.

INDICATIONS AND CONTRAINDICATIONS

Non-Physician Radiology Provider (NPRP)

IV.

INDICATIONS AND CONTRAINDICATIONS

Radiologic Technologist

Steroids

IV.

INDICATIONS AND CONTRAINDICATIONS

Nursing Services

Local Anesthetics

SPECIFICATIONS OF THE PROCEDURE

Patient Care

Preprocedural Care

SPECIFICATIONS OF THE PROCEDURE

Guidance

SPECIFICATIONS OF THE PROCEDURE

Guidance

Procedural Care

SPECIFICATIONS OF THE PROCEDURE

Technique

SPECIFICATIONS OF THE PROCEDURE

Technique

Postprocedural Care

SPECIFICATIONS OF THE PROCEDURE

Medications

VI.

QUALIFICATIONS AND RESPONSIBILITIES OF PERSONNEL

Surgical and Emergency Support

VII.

QUALITY IMPROVEMENT AND DOCUMENTATION

VII.

QUALITY IMPROVEMENT AND DOCUMENTATION

Patient Care

VII.

QUALITY IMPROVEMENT AND DOCUMENTATION

Informed Consent

VIII.

EQUIPMENT QUALITY CONTROL

VIII.

EQUIPMENT QUALITY CONTROL

Informed Consent and Procedural Risk

VIII.

EQUIPMENT QUALITY CONTROL

Documentation

IX.

RADIATION SAFETY IN IMAGING

Informed Consent and Procedural Risk

QUALITY CONTROL AND IMPROVEMENT, SAFETY, INFECTION CONTROL, AND PATIENT EDUCATION

Success and Complication Thresholds

XI.

ACKNOWLEDGEMENTS

Writing Committee – members represent their societies in the initial and final revision of this practice parameter

ACR Blackham, Kristine A MD, Chair Amrhein, Timothy J MD Smirniotopoulos, John MD	ASNR Barr, John MD Gibbs, Wende N. MD Thaker, Ashesh A MD	SNIS Brook, Allan L MD Ortiz, A. Orlando MBA, MD	ASSR Brown, Patrick MD Lee, Seon-Kyu MD, PhD Vander Velde, Theodore L MD
SIR Gupta, Amit MD Johnson, Thor MD

Committee on Practice Parameters – Neuroradiology

(ACR Committee responsible for sponsoring the draft through the process)

Shah, Lubdha M MD, Chair	Aiken, Ashley H MD	Amrhein, Timothy J MD	Austin, Matthew J MD
Becker, Jennifer L MD	Blackham, Kristine A MD	Chaudhry, Umar S MD	Chiang, Gloria C MD
Hutchins, Troy A MD	Mazaheri, Parisa MD	Ormsby, Jacob MBA, MD	Riley, Kalen MD
Sio, Terence Tai-Weng MD, MS

Committee on Practice Parameters and Technical Standards

(ACR Committee responsible for sponsoring the draft through the process)

Caplin, Drew M MD, Chair

Committee on Practice Parameters – Interventional and Cardiovascular Radiology

(ACR Committee responsible for sponsoring the draft through the process)

Kaufman, Claire MD, Chair	Daly, Kevin MD	Dickey, Kevin MD	Gurusamy, Varshana MD
Kay, Dennis MD	Landinez, Gina MD	Marx, M Victoria MD	Monfore, Natosha N DO
Noor, Amir MD	Tomihama, Roger T MD

Jordan, John E MD, Chair, Commission on Neuroradiology

Larson, David B MBA, MD, Chair, Commission on Quality and Safety

Min, Robert MD, Chair, Commission on Interventional Radiology & Cardiovascular Imaging

Comments Reconciliation Committee

Amrhein, Timothy J MD	Barr, John MD	Batlle, Juan C MBA, MD - CSC	Blackham, Kristine A MD
Brook, Allan L MD	Brown, Patrick MD	Caplin, Drew M MD	Chu, Sammy MD - CSC
Gibbs, Wende N. MD	Gupta, Amit MD	Johnson, Thor MD	Jordan, John E MD
Kaufman, Claire MD	Larson, David B MBA, MD	Lee, Seon-Kyu MD, PhD	Min, Robert MD
Ortiz, A. Orlando MBA, MD	Shah, Lubdha M MD	Smirniotopoulos, John MD	Thaker, Ashesh A MD
Vander Velde, Theodore L MD

XII.

REFERENCES

1. BicketMark CMCDepartment of Anesthesiology, Critical Care & Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA., ChakravarthyKrishnanK, ChangDavidD, CohenSteven PSP. Epidural steroid injections: an updated review on recent trends in safety and complications. Pain Manag 5:129-46, .
2. PetersonCynthiaCRadiology, Orthopaedic University Hospital of Balgrist, Forchstrasse 340, 8008 Zürich, Switzerland. cynthia.peterson@balgrist.ch, HodlerJuergJ. Evidence-based radiology (part 1): Is there sufficient research to support the use of therapeutic injections for the spine and sacroiliac joints?. Skeletal Radiol 39:5-9, .
3. Food and Drug Administration. FDA drug safety communication: FDA requires label changes to warn of rare but serious neurologic problems after epidural corticosteroid injections for pain. Available at: https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-requires-label-changes-warn-rare-serious-neurologic-problems-after.
4. Bogduk N. Practice guidelines for spinal diagnostic and treatment procedures. 2nd ed: International Spine Intervention Society; 2013.
5. Rathmell JP, Benzon HT, Dreyfuss P, et al. Safeguards to prevent neurologic complications after epidural steroid injections: consensus opinions from a multidisciplinary working group and national organizations. Anesthesiology. 2015 May;122(5):974-84.
6. ManchikantiLaxmaiahLPain Management Center of Paducah, Paducah, KY, and University of Louisville, Louisville, KY., CandidoKenneth DKD, SinghVijayV, et al. Epidural steroid warning controversy still dogging FDA. Pain Physician 17:E451-74, .
7. Benyamin RM, Manchikanti L, Parr AT, et al. The effectiveness of lumbar interlaminar epidural injections in managing chronic low back and lower extremity pain. Pain Physician. 2012;15(4):E363-404.
8. Olmarker K, Rydevik B, Holm S. Edema formation in spinal nerve roots induced by experimental, graded compression. An experimental study on the pig cauda equina with special reference to differences in effects between rapid and slow onset of compression. Spine (Phila Pa 1976). 1989 Jun;14(6):569-73.
9. Rydevik B, Brown MD, Lundborg G. Pathoanatomy and pathophysiology of nerve root compression. Spine (Phila Pa 1976). 1984;9(1):7-15.
10. Lin;JH, Chiang YH, Chen CC. Lumbar radiculopathy and its neurobiological basis. World J Anesthesiol 2014;3:162-73.
11. Abram SE, O'Connor TC. Complications associated with epidural steroid injections. Reg Anesth. 1996;21(2):149-62.
12. Derby R, Lee SH, Date ES, Lee JH, Lee CH. Size and aggregation of corticosteroids used for epidural injections. Pain Med. 2008 Mar;9(2):227-34.
13. Johansson A, Hao J, Sjölund B. Local corticosteroid application blocks transmission in normal nociceptive C-fibres. Acta Anaesthesiol Scand. 1990 Jul;34(5):335-8.
14. Kantrowitz F, Robinson DR, McGuire MB, Levine L. Corticosteroids inhibit prostaglandin production by rheumatiod synovia. Nature. 1975 Dec 25;258(5537):737-9.
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 (Phila Pa 1976). 1990 Jul;15(7):674-8.
16. Chou RR, Hashimoto RR, Friedly JJ, et al. Pain Management Injection Therapies for Low Back Pain.
17. Bicket MM, Gupta AA, Brown CC, Cohen SS. Epidural injections for spinal pain: a systematic review and meta-analysis evaluating the "control" injections in randomized controlled trials. Anesthesiology 119:907-31, .
18. Kaufmann TT, Geske JJ, Murthy NN, et al. Clinical effectiveness of single lumbar transforaminal epidural steroid injections. Pain Med 14:1126-33, .
19. MacVicar JJ, King WW, Landers MM, Bogduk NN. The effectiveness of lumbar transforaminal injection of steroids: a comprehensive review with systematic analysis of the published data. Pain Med 14:14-28, .
20. Manchikanti LL, Buenaventura RR, Manchikanti KK, et al. Effectiveness of therapeutic lumbar transforaminal epidural steroid injections in managing lumbar spinal pain. Pain Physician 15:E199-245, .
21. Byröd GG, Otani KK, Brisby HH, Rydevik BB, Olmarker KK. Methylprednisolone reduces the early vascular permeability increase in spinal nerve roots induced by epidural nucleus pulposus application. J Orthop Res 18:983-7, .
22. Hayashi NN, Weinstein JJ, Meller SS, Lee HH, Spratt KK, Gebhart GG. The effect of epidural injection of betamethasone or bupivacaine in a rat model of lumbar radiculopathy. Spine (Phila Pa 1976) 23:877-85, .
23. Lee HH, Weinstein JJ, Meller SS, Hayashi NN, Spratt KK, Gebhart GG. The role of steroids and their effects on phospholipase A2. An animal model of radiculopathy. Spine (Phila Pa 1976) 23:1191-6, .
24. Minamide AA, Tamaki TT, Hashizume HH, Yoshida MM, Kawakami MM, Hayashi NN. Effects of steroid and lipopolysaccharide on spontaneous resorption of herniated intervertebral discs. An experimental study in the rabbit. Spine (Phila Pa 1976) 23:870-6, .
25. Olmarker KK, Nutu MM, Størkson RR. Changes in spontaneous behavior in rats exposed to experimental disc herniation are blocked by selective TNF-alpha inhibition. Spine (Phila Pa 1976) 28:1635-41; discussion 1642, .
26. Lundin AA, Magnuson AA, Axelsson KK, Nilsson OO, Samuelsson LL. Corticosteroids peroperatively diminishes damage to the C-fibers in microscopic lumbar disc surgery. Spine (Phila Pa 1976) 30:2362-7; discussion 2368, .
27. Manchikanti LL, Knezevic NN, Boswell MM, Kaye AA, Hirsch JJ. Epidural Injections for Lumbar Radiculopathy and Spinal Stenosis: A Comparative Systematic Review and Meta-Analysis. Pain Physician 19:E365-410, .
28. Ye LL, Xie WW, Strong JJ, Zhang JJ. Blocking the mineralocorticoid receptor improves effectiveness of steroid treatment for low back pain in rats. Anesthesiology 121:632-43, .
29. Friedly JJ, Comstock BB, Turner JJ, et al. A randomized trial of epidural glucocorticoid injections for spinal stenosis. N Engl J Med 371:11-21, .
30. Manchikanti L, Kaye AD, Manchikanti K, Boswell M, Pampati V, Hirsch J. Efficacy of epidural injections in the treatment of lumbar central spinal stenosis: a systematic review. Anesth Pain Med. 2015 Feb;5(1):e23139.
31. MacMahon PJ, Eustace SJ, Kavanagh EC. Injectable corticosteroid and local anesthetic preparations: a review for radiologists. Radiology. 2009 Sep;252(3):647-61.
32. Arnér S, Lindblom U, Meyerson BA, Molander C. Prolonged relief of neuralgia after regional anesthetic blocks. A call for further experimental and systematic clinical studies. Pain. 1990 Dec;43(3):287-297.
33. Cassuto J, Sinclair R, Bonderovic M. Anti-inflammatory properties of local anesthetics and their present and potential clinical implications. Acta Anaesthesiol Scand. 2006 Mar;50(3):265-82.
34. Kaye AD, Manchikanti L, Abdi S, et al. Efficacy of Epidural Injections in Managing Chronic Spinal Pain: A Best Evidence Synthesis. Pain Physician. 2015 Nov;18(6):E939-1004.
35. Lavoie PA, Khazen T, Filion PR. Mechanisms of the inhibition of fast axonal transport by local anesthetics. Neuropharmacology. 1989 Feb;28(2):175-81.
36. Manchikanti L, Abdi S, Atluri S, et al. An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and recommendations. Pain Physician. 2013 Apr;16(2 Suppl):S49-283.
37. Manchikanti L, Benyamin RM, Falco FJ, Kaye AD, Hirsch JA. Do Epidural Injections Provide Short- and Long-term Relief for Lumbar Disc Herniation? A Systematic Review. Clin Orthop Relat Res. 2015 Jun;473(6):1940-56.
38. Manchikanti L, Nampiaparampil DE, Manchikanti KN, et al. Comparison of the efficacy of saline, local anesthetics, and steroids in epidural and facet joint injections for the management of spinal pain: A systematic review of randomized controlled trials. Surg Neurol Int. 2015;6(Suppl 4):S194-235.
39. Pasqualucci A. Experimental and clinical studies about the preemptive analgesia with local anesthetics. Possible reasons of the failure. Minerva Anestesiol. 1998 Oct;64(10):445-57.
40. Moen GG, Moen AA, Schistad EE, Gjerstad JJ. Local up-regulation of interferon-? (IFN-?) following disc herniation is involved in the inflammatory response underlying acute lumbar radicular pain. Cytokine 97:181-186, .
41. Linton SJ, Boersma K, Jansson M, Svärd L, Botvalde M. The effects of cognitive-behavioral and physical therapy preventive interventions on pain-related sick leave: a randomized controlled trial. Clin J Pain. 2005;21(2):109-19.
42. Kim JJ, Burke SS, Kryzanski JJ, et al. The Role of Liposomal Bupivacaine in Reduction of Postoperative Pain After Transforaminal Lumbar Interbody Fusion: A Clinical Study. World Neurosurg 91:460-7, .
43. Rabinovitch DD, Peliowski AA, Furlan AA. Influence of lumbar epidural injection volume on pain relief for radicular leg pain and/or low back pain. Spine J 9:509-17, .
44. Manchikanti LL, Cash KK, McManus CC, Pampati VV, Fellows BB. Fluoroscopic caudal epidural injections with or without steroids in managing pain of lumbar spinal stenosis: one-year results of randomized, double-blind, active-controlled trial. J Spinal Disord Tech 25:226-34, .
45. Racz GB, Day MR, Heavner JE, Scott J. Lysis of epidural adhesions: the racztechnique. In: Waldman SD, ed. Pain Management. 2nd edition ed. Philadelphia, PA: Elsevier Saunders; 2011:1258-72.
46. Parkin IG, Harrison GR. The topographical anatomy of the lumbar epidural space. J Anat 1985;141:211-17.
47. Kimmell KT, Dayoub H, Shakir H, Sincoff EH. Spinal dural attachments to the vertebral column: An anatomic report and review of the literature. Surg Neurol Int. 2011;2():97.
48. Morisot P. [Is posterior lumbar epidural space partitioned?]. Ann Fr Anesth Reanim. 1992;11(1):72-81.
49. Manchikanti L, Falco FJ, Benyamin RM, Gharibo CG, Candido KD, Hirsch JA. Epidural steroid injections safety recommendations by the Multi-Society Pain Workgroup (MPW): more regulations without evidence or clarification. Pain Physician. 2014;17(5):E575-88.
50. Koontz NA, Wiggins RH, Stoddard GJ, Shah LM. Do Superior or Inferior Interlaminar Approach or Bevel Orientation Predispose to Nonepidural Needle Penetration?. AJR Am J Roentgenol. 2017 Oct;209(4):895-903.
51. Huang AJ, Rosenthal DI, Palmer WE. Inadvertent intra-articular lumbar facet joint injection during fluoroscopically guided interlaminar epidural steroid injection. Skeletal Radiology. 40(1):33-45, 2011 Jan.
52. Lehman VT, Murthy NS, Diehn FE, Verdoorn JT, Maus TP. The posterior ligamentous complex inflammatory syndrome: spread of fluid and inflammation in the retrodural space of Okada. [Review]. Clinical Radiology. 70(5):528-35, 2015 May.
53. Murthy NS, Maus TP, Aprill C. The retrodural space of Okada. [Review]. AJR. American Journal of Roentgenology. 196(6):W784-9, 2011 Jun.
54. Huang AJ, Palmer WE. Incidence of inadvertent intra-articular lumbar facet joint injection during fluoroscopically guided interlaminar epidural steroid injection. Skeletal Radiology. 41(2):157-62, 2012 Feb.
55. Kranz PG, Joshi AB, Roy LA, Choudhury KR, Amrhein TJ. Inadvertent Intrafacet Injection during Lumbar Interlaminar Epidural Steroid Injection: A Comparison of CT Fluoroscopic and Conventional Fluoroscopic Guidance. AJNR Am J Neuroradiol. 2017 Feb;38(2):398-402.
56. Aldrete JA, Mushin AU, Zapata JC, Ghaly R. Skin to cervical epidural space distances as read from magnetic resonance imaging films: consideration of the "hump pad.". J Clin Anesth. 1998 Jun;10(4):309-13.
57. Goel A, Pollan JJ. Contrast flow characteristics in the cervical epidural space: an analysis of cervical epidurograms. Spine (Phila Pa 1976). 2006 Jun 15;31(14):1576-9.
58. Hodges SD, Castleberg RL, Miller T, Ward R, Thornburg C. Cervical epidural steroid injection with intrinsic spinal cord damage. Two case reports. Spine (Phila Pa 1976). 1998 Oct 01;23(19):2137-42; discussion 2141-2.
59. Hogan QH. Epidural anatomy examined by cryomicrotome section. Influence of age, vertebral level, and disease. Reg Anesth. 1996;21(5):395-406.
60. Manchikanti L, Rajgopal R, Pampati V. Comparison of three routes of epidural steroid injections in low back pain. Pain Digest 1999;9:277-85.
61. Furman MB, Cuneo AA. Image and Contrast Flow Pattern Interpretation for Attempted Epidural Steroid Injections. Phys Med Rehabil Clin N Am. 2018 Feb;29(1):S1047-9651(17)30070-0.
62. Jeong HS, Lee JW, Kim SH, Myung JS, Kim JH, Kang HS. Effectiveness of transforaminal epidural steroid injection by using a preganglionic approach: a prospective randomized controlled study. Radiology. 2007 Nov;245(2):584-90.
63. Kamble PC, Sharma A, Singh V, Natraj B, Devani D, Khapane V. Outcome of single level disc prolapse treated with transforaminal steroid versus epidural steroid versus caudal steroids. Eur Spine J. 2016 Jan;25(1):217-221.
64. Shim E, Lee JW, Lee E, Ahn JM, Kang Y, Kang HS. Fluoroscopically Guided Epidural Injections of the Cervical and Lumbar Spine. [Review]. Radiographics. 37(2):537-561, 2017 Mar-Apr.
65. Manchikanti L, Cash KA, Pampati V, Damron KS, McManus CD. Evaluation of lumbar transforaminal epidural injections with needle placement and contrast flow patterns: a prospective, descriptive report. Pain Physician. 2004 Apr;7(2):217-23.
66. Botwin KP, Gruber RD, Bouchlas CG, et al. Fluoroscopically guided lumbar transformational epidural steroid injections in degenerative lumbar stenosis: an outcome study. Am J Phys Med Rehabil. 2002 Dec;81(12):898-905.
67. Slipman CW, Chow DW. Therapeutic spinal corticosteroid injections for the management of radiculopathies. Phys Med Rehabil Clin N Am. 2002 Aug;13(3):697-711.
68. Boswell MV, Hansen HC, Trescot AM, Hirsch JA. Epidural steroids in the management of chronic spinal pain and radiculopathy. Pain Physician. 2003 Jul;6(3):319-34.
69. Botwin KP, Gruber RD, Bouchlas CG, Torres-Ramos FM, Freeman TL, Slaten WK. Complications of fluoroscopically guided transforaminal lumbar epidural injections. Arch Phys Med Rehabil. 2000 Aug;81(8):1045-50.
70. Elias M. A rare cause of radiculopathy following transformainal epidual steroid injection. Pain Clinic 1998;11:159-60.
71. Furman MB, O'Brien EM, Zgleszewski TM. Incidence of intravascular penetration in transforaminal lumbosacral epidural steroid injections. Spine (Phila Pa 1976). 2000 Oct 15;25(20):2628-32.
72. Houten JK, Errico TJ. Paraplegia after lumbosacral nerve root block: report of three cases. Spine J. 2002;2(1):70-5.
73. Manchikanti L. Transforaminal lumbar epidural steroid injections. Pain Physician. 2000 Oct;3(4):374-98.
74. Manchikanti L, Staats PS, Singh V, et al. Evidence-based practice guidelines for interventional techniques in the management of chronic spinal pain. Pain Physician. 6(1):3-81, 2003 Jan.
75. Stöhr M, Mayer K. [Nerve-root damage from local injections (author's transl)]. Dtsch Med Wochenschr. 1976 Aug 13;101(33):1218-20.
76. Kambin P, Sampson S. Posterolateral percutaneous suction-excision of herniated lumbar intervertebral discs. Report of interim results. Clin Orthop Relat Res. 1986 Jun;(207):37-43.
77. Murthy NS, Maus TP, Behrns CL. Intraforaminal location of the great anterior radiculomedullary artery (artery of Adamkiewicz): a retrospective review. Pain Med. 2010 Dec;11(12):1756-64.
78. Levi D, Horn S, Corcoran S. The Incidence of Intradiscal, Intrathecal, and Intravascular Flow During the Performance of Retrodiscal (Infraneural) Approach for Lumbar Transforaminal Epidural Steroid Injections. Pain Med. 2016 Aug;17(8):1416-22.
79. Smuck M, Paulus S, Patel A, Demirjian R, Ith MA, Kennedy DJ. Differential Rates of Inadvertent Intravascular Injection during Lumbar Transforaminal Epidural Injections Using Blunt-Tip, Pencil-Point, and Catheter-Extension Needles. Pain Med. 2015 Nov;16(11):2084-9.
80. Özcan U, Sahin S, Gurbet A, Türker G, Özgür M, Çelebi S. Comparison of blunt and sharp needles for transforaminal epidural steroid injections. Agri. 2012;24(2):85-9.
81. Trinh KH, Gharibo CG, Aydin SM. Inadvertent Intradiscal Injection with TFESI Utilizing Kambin's Retrodiscal Approach in the Treatment of Acute Lumbar Radiculopathy. Pain Pract. 2016 Apr;16(4):E70-3.
82. Provenzano DA, Fanciullo G. Cervical transforaminal epidural steroid injections: should we be performing them?. Reg Anesth Pain Med. 2007;32(2):168; author reply 169-70.
83. Choi E, Nahm FS, Lee PB. Comparison of contrast flow and clinical effectiveness between a modified paramedian interlaminar approach and transforaminal approach in cervical epidural steroid injection. Br J Anaesth. 115(5):768-74, 2015 Nov.
84. Hoang JK, Apostol MA, Kranz PG, et al. CT fluoroscopy-assisted cervical transforaminal steroid injection: tips, traps, and use of contrast material. AJR Am J Roentgenol. 2010 Oct;195(4):888-94.
85. Wagner AL. CT fluoroscopic-guided cervical nerve root blocks. AJNR Am J Neuroradiol. 2005 Jan;26(1):43-4.
86. Richarme D, Thevenin FS, Chevrot A, et al. Cervical radiculopathy: efficiency of CT-guided cervical facet joint corticosteroid injection. Chicago, IL: Radiological Society of North America; 2008.
87. Kim KH, Choi SH, Kim TK, Shin SW, Kim CH, Kim JI. Cervical facet joint injections in the neck and shoulder pain. J Korean Med Sci. 2005 Aug;20(4):659-62.
88. Bureau NJ, Moser T, Dagher JH, et al. Transforaminal versus intra-articular facet corticosteroid injections for the treatment of cervical radiculopathy: a randomized, double-blind, controlled study. AJNR Am J Neuroradiol. 2014 Aug;35(8):1467-74.
89. Eckel TS, Bartynski WS. Epidural steroid injections and selective nerve root blocks. Tech Vasc Interv Radiol. 2009 Mar;12(1):11-21.
90. Kao SC, Lin CS. Caudal Epidural Block: An Updated Review of Anatomy and Techniques. [Review]. Biomed Res Int. 2017:9217145, 2017.
91. Wolff MW, Levine LA. Cervical radiculopathies: conservative approaches to management. Phys Med Rehabil Clin N Am. 2002 Aug;13(3):589-608, vii.
92. Murakibhavi VG, Khemka AG. Caudal epidural steroid injection: a randomized controlled trial. Evid Based Spine Care J. 2011 Nov;2(4):19-26.
93. Hooten WM, Cohen SP. Evaluation and Treatment of Low Back Pain: A Clinically Focused Review for Primary Care Specialists. [Review]. Mayo Clinic Proceedings. 90(12):1699-718, 2015 Dec.
94. Brzezicki GG, Jankowski RR, Blok TT, et al. Postlaminectomy osteopontin expression and associated neurophysiological findings in rat peridural scar model. Spine (Phila Pa 1976) 36:378-85, .
95. Fritsch EE, Heisel JJ, Rupp SS. The failed back surgery syndrome: reasons, intraoperative findings, and long-term results: a report of 182 operative treatments. Spine (Phila Pa 1976) 21:626-33, .
96. Law JJ, Lehman RR, Kirsch WW. Reoperation after lumbar intervertebral disc surgery. J Neurosurg 48:259-63, .
97. Manchikanti L, Boswell MV, Singh V, et al. Comprehensive evidence-based guidelines for interventional techniques in the management of chronic spinal pain. Pain Physician. 12(4):699-802, 2009 Jul-Aug.
98. Manchikanti L, Manchukonda R, Pampati V, Damron KS, McManus CD. Prevalence of facet joint pain in chronic low back pain in postsurgical patients by controlled comparative local anesthetic blocks. Archives of Physical Medicine & Rehabilitation. 88(4):449-55, 2007 Apr.
99. Osterman HH, Sund RR, Seitsalo SS, Keskimäki II. Risk of multiple reoperations after lumbar discectomy: a population-based study. Spine (Phila Pa 1976) 28:621-7, .
100. Ross JJ, Robertson JJ, Frederickson RR, et al. Association between peridural scar and recurrent radicular pain after lumbar discectomy: magnetic resonance evaluation. ADCON-L European Study Group. Neurosurgery 38:855-61; discussion 861-3, .
101. Waddell GG, Kummel EE, Lotto WW, Graham JJ, Hall HH, McCulloch JJ. Failed lumbar disc surgery and repeat surgery following industrial injuries. J Bone Joint Surg Am 61:201-7, .
102. Manchikanti LL, Singh VV, Cash KK, Pampati VV, Datta SS. Fluoroscopic caudal epidural injections in managing post lumbar surgery syndrome: two-year results of a randomized, double-blind, active-control trial. Int J Med Sci 9:582-91, .
103. Yousef AA, EL-Deen AA, Al-Deeb AA. The role of adding hyaluronidase to fluoroscopically guided caudal steroid and hypertonic saline injection in patients with failed back surgery syndrome: a prospective, double-blinded, randomized study. Pain Pract 10:548-53, .
104. Collighan N, S G. Continuing Education in Anaesthesia Critical Care & Pain; 2009.
105. Friedrich JJ, Harrast MM. Lumbar epidural steroid injections: indications, contraindications, risks, and benefits. Curr Sports Med Rep 9:43-9, .
106. Narouze S, Benzon HT, Provenzano D, et al. Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications (Second Edition): Guidelines From the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain. Reg Anesth Pain Med. 2018 Apr;43(3):225-262.
107. White AH, Derby R, Wynne G. Epidural injections for the diagnosis and treatment of low-back pain. Spine (Phila Pa 1976). 1980;5(1):78-86.
108. Desmond FA, Harmon D. Ultrasound-guided symphysis pubis injection in pregnancy. Anesth Analg. 2010 Nov;111(5):1329-30.
109. Kalin A, Woods D. Neuraxial blockade in a patient with hepatitis C. Can J Anesthesia 2008;Supplement vol. 55.
110. Abram SS. Treatment of lumbosacral radiculopathy with epidural steroids. Anesthesiology 91:1937-41, .
111. American College of Radiology. ACR Practice Parameter for Continuing Medical Education. Available at https://gravitas.acr.org/PPTS/GetDocumentView?docId=130+&releaseId=2
112. Johnson BA. Image-guided epidural injections. Neuroimaging Clin N Am. 2000 Aug;10(3):479-91.
113. Watanabe AT, Nishimura E, Garris J. Image-guided epidural steroid injections. Tech Vasc Interv Radiol. 2002 Dec;5(4):186-93.
114. Mathis JM. Epidural steroid injections. Neuroimaging Clin N Am. 2010 May;20(2):193-202.
115. Paulson EK, Sheafor DH, Enterline DS, McAdams HP, Yoshizumi TT. CT fluoroscopy--guided interventional procedures: techniques and radiation dose to radiologists. Radiology. 2001 Jul;220(1):161-7.
116. Fenster AJ, Fernandes K, Brook AL, Miller T. The Safety of CT-Guided Epidural Steroid Injections in an Older Patient Cohort. Pain physician. 19(8):E1139-E1146, 2016 Nov-Dec.
117. Lazarus MS, Forman RB, Brook AL, Miller TS. Radiation Dose and Procedure Time for 994 CT-guided Spine Pain Control Procedures. Pain Physician. 2017 May;20(4):E585-E591.
118. Amrhein TJ, Schauberger JS, Kranz PG, Hoang JK. Reducing Patient Radiation Exposure From CT Fluoroscopy-Guided Lumbar Spine Pain Injections by Targeting the Planning CT. AJR Am J Roentgenol. 206(2):390-4, 2016 Feb.
119. Wagner AL. CT fluoroscopy-guided epidural injections: technique and results. AJNR Am J Neuroradiol. 2004;25(10):1821-3.
120. Viola RJ, Nguyen GB, Yoshizumi TT, Stinnett SS, Hoang JK, Kranz PG. Effect of Body Habitus on Radiation Dose During CT Fluoroscopy-Guided Spine Injections. Interv Neuroradiol. 2014 Oct 31;20(5):525-32.
121. Jee H, Lee JH, Kim J, Park KD, Lee WY, Park Y. Ultrasound-guided selective nerve root block versus fluoroscopy-guided transforaminal block for the treatment of radicular pain in the lower cervical spine: a randomized, blinded, controlled study. Skeletal Radiology. 42(1):69-78, 2013 Jan.
122. Bartynski WW, Grahovac SS, Rothfus WW. Incorrect needle position during lumbar epidural steroid administration: inaccuracy of loss of air pressure resistance and requirement of fluoroscopy and epidurography during needle insertion. AJNR Am J Neuroradiol 26:502-5, .
123. Benzon HH, Huntoon MM, Rathmell JJ. Improving the safety of epidural steroid injections. JAMA 313:1713-4, .
124. Kim YY, Kim DD, Park JJ, et al. Method to Reduce the False-Positive Rate of Loss of Resistance in the Cervical Epidural Region. Pain Res Manag 2016:9894054, .
125. Saberski LL, Kondamuri SS, Osinubi OO. Identification of the epidural space: is loss of resistance to air a safe technique? A review of the complications related to the use of air. Reg Anesth 22:3-15, .
126. Goodman BB, Posecion LL, Mallempati SS, Bayazitoglu MM. Complications and pitfalls of lumbar interlaminar and transforaminal epidural injections. Curr Rev Musculoskelet Med 1:212-22, .
127. Bolger MM, MacMahon PP, Kavanagh EE. Is There a Need for Contrast and Local Anesthetic in Cervical Epidural Steroid Injections?. AJNR Am J Neuroradiol 37:E61, .
128. Ryan TT, Kavanagh EE, MacMahon PP. Is there a need for contrast administration prior to CT-guided cervical nerve root block?. AJNR Am J Neuroradiol 34:E45, .
129. Hong JJ, Kim SS, Huh BB, Shin HH. Analysis of inadvertent intradiscal and intravascular injection during lumbar transforaminal epidural steroid injections: a prospective study. Reg Anesth Pain Med 38:520-5, .
130. Lee MM, Yang KK, Kim YY, Jung HH, Lim SS, Moon DD. Accuracy of live fluoroscopy to detect intravascular injection during lumbar transforaminal epidural injections. Korean J Pain 23:18-23, .
131. McLean JP, Sigler JD, Plastaras CT, Garvan CW, Rittenberg JD. The rate of detection of intravascular injection in cervical transforaminal epidural steroid injections with and without digital subtraction angiography. Pm & R. 1(7):636-42, 2009 Jul.
132. Chang AA, Pochert SS, Romano CC, Brook AA, Miller TT. Safety of 1000 CT-guided steroid injections with air used to localize the epidural space. AJNR Am J Neuroradiol 32:E175-7, .
133. International Electrotechnical Commission. Medical electrical equipment - part 1: general requirements for basic safety and essential performance. Available at: http://www.ele.uri.edu/courses/bme484/iec60601-1ed3.0_parts.pdf.
134. Benzon HH, Chew TT, McCarthy RR, Benzon HH, Walega DD. Comparison of the particle sizes of different steroids and the effect of dilution: a review of the relative neurotoxicities of the steroids. Anesthesiology 106:331-8, .
135. MacMahon PP, Huang AA, Palmer WW. Spine Injectables: What Is the Safest Cocktail?. AJR Am J Roentgenol 207:526-33, .
136. MacMahon PJ, Shelly MJ, Scholz D, Eustace SJ, Kavanagh EC. Injectable corticosteroid preparations: an embolic risk assessment by static and dynamic microscopic analysis. AJNR Am J Neuroradiol. 2011;32(10):1830-5.
137. Gharibo CC, Fakhry MM, Diwan SS, Kaye AA. Conus Medullaris Infarction After a Right L4 Transforaminal Epidural Steroid Injection Using Dexamethasone. Pain Physician 19:E1211-E1214, .
138. Friedly JJ, Comstock BB, Heagerty PP, et al. Systemic effects of epidural steroid injections for spinal stenosis. Pain 159:876-883, .
139. Mathis JM, Golovac S, Cho CH. Pharmaceuticals used in image-guided spine interventions. Neuroimaging Clin N Am. 20(2):215-22, 2010 May.
140. Owlia MM, Salimzadeh AA, Alishiri GG, Haghighi AA. Comparison of two doses of corticosteroid in epidural steroid injection for lumbar radicular pain. Singapore Med J 48:241-5, .
141. Kang SS, Hwang BB, Son HH, et al. The dosages of corticosteroid in transforaminal epidural steroid injections for lumbar radicular pain due to a herniated disc. Pain Physician 14:361-70, .
142. Krunic AA, Wang LL, Soltani KK, Weitzul SS, Taylor RR. Digital anesthesia with epinephrine: an old myth revisited. J Am Acad Dermatol 51:755-9, .
143. Leone SS, Di Cianni SS, Casati AA, Fanelli GG. Pharmacology, toxicology, and clinical use of new long acting local anesthetics, ropivacaine and levobupivacaine. Acta Biomed 79:92-105, .
144. Foster AA, Carlson BB. Myotoxicity of local anesthetics and regeneration of the damaged muscle fibers. Anesth Analg 59:727-36, .
145. Hogan QQ, Dotson RR, Erickson SS, Kettler RR, Hogan KK. Local anesthetic myotoxicity: a case and review. Anesthesiology 80:942-7, .
146. Zink WW, Graf BB. Local anesthetic myotoxicity. Reg Anesth Pain Med 29:333-40, .
147. Sisk AA. Vasoconstrictors in local anesthesia for dentistry. Anesth Prog 39:187-93, .
148. Narouze S, Benzon HT, Provenzano DA, et al. Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications: guidelines from the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain. Reg Anesth Pain Med. 2015;40(3):182-212.
149. Nickalls RW, Kokri MS. The width of the posterior epidural space in obstetric patients. Anaesthesia. 1986 Apr;41(4):432-3.
150. Reina MA, Franco CD, López A, Dé Andrés JA, van Zundert A. Clinical implications of epidural fat in the spinal canal. A scanning electron microscopic study. Acta Anaesthesiol Belg. 2009;60(1):7-17.
151. Igarashi TT, Hirabayashi YY, Shimizu RR, Saitoh KK, Fukuda HH, Mitsuhata HH. The lumbar extradural structure changes with increasing age. Br J Anaesth 78:149-52, .
152. Wu HH, Schweitzer MM, Parker LL. Is epidural fat associated with body habitus?. J Comput Assist Tomogr 29:99-102, .
153. Cohen SS, Gupta AA, Strassels SS, et al. Effect of MRI on treatment results or decision making in patients with lumbosacral radiculopathy referred for epidural steroid injections: a multicenter, randomized controlled trial. Arch Intern Med 172:134-42, .
154. Maus T. Imaging the back pain patient. Phys Med Rehabil Clin N Am. 2010 Nov;21(4):725-66.
155. Maus TP, El-Yahchouchi CA, Geske JR, et al. Imaging Determinants of Clinical Effectiveness of Lumbar Transforaminal Epidural Steroid Injections. Pain Medicine. 17(12):2176-2184, 2016 12.
156. Smith CC, Lin JL, Shokat M, Dosanjh SS, Casthely D. A report of paraparesis following spinal cord stimulator trial, implantation and revision. Pain Physician. 2010;13(4):357-63.
157. Igarashi TT, Hirabayashi YY, Shimizu RR, et al. Inflammatory changes after extradural anaesthesia may affect the spread of local anaesthetic within the extradural space. Br J Anaesth 77:347-51, .
158. Mangram AA, Horan TT, Pearson MM, Silver LL, Jarvis WW. Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 27:97-132; quiz 133-4; discussion 96, .
159. American College of Radiology. ACR–SIR Practice Parameter For Minimal and/or Moderate Sedation/Analgesia. Available at https://gravitas.acr.org/PPTS/GetDocumentView?docId=95+&releaseId=2
160. Rathmell JP, Michna E, Fitzgibbon DR, Stephens LS, Posner KL, Domino KB. Injury and liability associated with cervical procedures for chronic pain. Anesthesiology. 114(4):918-26, 2011 Apr.
161. American College of Radiology. ACR–AAPM Technical Standard for Diagnostic Medical Physics Performance Monitoring of Computed Tomography (CT) Equipment. Available at https://gravitas.acr.org/PPTS/GetDocumentView?docId=131+&releaseId=2
162. American College of Radiology. ACR–AAPM TECHNICAL STANDARD FOR DIAGNOSTIC MEDICAL PHYSICS PERFORMANCE MONITORING OF FLUOROSCOPIC EQUIPMENT. Available at https://gravitas.acr.org/PPTS/GetDocumentView?docId=117+&releaseId=2
163. American College of Radiology. ACR–AAPM Technical Standard for Diagnostic Medical Physics Performance Monitoring of Magnetic Resonance (MR) Imaging Equipment. Available at https://gravitas.acr.org/PPTS/GetDocumentView?docId=57+&releaseId=2
164. American College of Radiology. ACR–AAPM Technical Standard for Diagnostic Medical Physics Performance Monitoring of Real Time Ultrasound Equipment. Available at https://gravitas.acr.org/PPTS/GetDocumentView?docId=118+&releaseId=2
165. American College of Radiology. ACR–SIR–SPR Practice Parameter for the Reporting and Archiving of Interventional Radiology Procedures. Available at https://gravitas.acr.org/PPTS/GetDocumentView?docId=39+&releaseId=2
166. Amis EE, Butler PP, Applegate KK, et al. American College of Radiology white paper on radiation dose in medicine. J Am Coll Radiol 4:272-84, .
167. Miller DD, Balter SS, Wagner LL, et al. Quality improvement guidelines for recording patient radiation dose in the medical record. J Vasc Interv Radiol 15:423-9, .
168. Stecker MM, Balter SS, Towbin RR, et al. Guidelines for patient radiation dose management. J Vasc Interv Radiol 20:S263-73, .
169. American College of Radiology. ACR–SIR–SPR Practice Parameter on Informed Consent for Image-Guided Procedures. Available at https://gravitas.acr.org/PPTS/GetDocumentView?docId=176+&releaseId=2
170. Khalilzadeh OO, Baerlocher MM, Shyn PP, et al. Proposal of a New Adverse Event Classification by the Society of Interventional Radiology Standards of Practice Committee. J Vasc Interv Radiol 28:1432-1437.e3, .
171. Manchikanti LL, Hirsch JJ, Cohen SS, et al. Assessment of methodologic quality of randomized trials of interventional techniques: development of an interventional pain management specific instrument. Pain Physician 17:E263-90, .
172. Manchikanti LL, Hirsch JJ, Heavner JJ, et al. Development of an interventional pain management specific instrument for methodologic quality assessment of nonrandomized studies of interventional techniques. Pain Physician 17:E291-317, .
173. Manchikanti L, Cash KA, McManus CD, Pampati V, Smith HS. One-year results of a randomized, double-blind, active controlled trial of fluoroscopic caudal epidural injections with or without steroids in managing chronic discogenic low back pain without disc herniation or radiculitis. Pain Physician. 14(1):25-36, 2011 Jan-Feb.
174. Manchikanti L, Malla Y, Cash KA, McManus CD, Pampati V. Fluoroscopic epidural injections in cervical spinal stenosis: preliminary results of a randomized, double-blind, active control trial. Pain Physician. 15(1):E59-70, 2012 Jan-Feb.
175. Manchikanti LL, Cash KK, McManus CC, Damron KK, Pampati VV, Falco FF. A randomized, double-blind controlled trial of lumbar interlaminar epidural injections in central spinal stenosis: 2-year follow-up. Pain Physician 18:79-92, .
176. Manchikanti L, Cash KA, McManus CD, Pampati V, Benyamin RM. A randomized, double-blind, active-controlled trial of fluoroscopic lumbar interlaminar epidural injections in chronic axial or discogenic low back pain: results of 2-year follow-up. Pain Physician. 16(5):E491-504, 2013 Sep-Oct.
177. Manchikanti L, Cash KA, McManus CD, Pampati V, Benyamin RM. Thoracic interlaminar epidural injections in managing chronic thoracic pain: a randomized, double-blind, controlled trial with a 2-year follow-up. Pain Physician. 17(3):E327-38, 2014 May-Jun.
178. Manchikanti LL, Cash KK, McManus CC, Pampati VV, Fellows BB. Results of 2-year follow-up of a randomized, double-blind, controlled trial of fluoroscopic caudal epidural injections in central spinal stenosis. Pain Physician 15:371-84, .
179. Manchikanti LL, Cash KK, McManus CC, Pampati VV. Fluoroscopic caudal epidural injections in managing chronic axial low back pain without disc herniation, radiculitis, or facet joint pain. J Pain Res 5:381-90, .
180. Manchikanti LL, Cash KK, Pampati VV, Falco FF. Transforaminal epidural injections in chronic lumbar disc herniation: a randomized, double-blind, active-control trial. Pain Physician 17:E489-501, .
181. Manchikanti L, Cash KA, Pampati V, Malla Y. Two-year follow-up results of fluoroscopic cervical epidural injections in chronic axial or discogenic neck pain: a randomized, double-blind, controlled trial. International Journal of Medical Sciences. 11(4):309-20, 2014.
182. Manchikanti L, Cash KA, Pampati V, Wargo BW, Malla Y. A randomized, double-blind, active control trial of fluoroscopic cervical interlaminar epidural injections in chronic pain of cervical disc herniation: results of a 2-year follow-up.[Erratum appears in Pain Physician. 2013 Nov-Dec;16(6):609]. Pain Physician. 16(5):465-78, 2013 Sep-Oct.
183. Manchikanti LL, Singh VV, Cash KK, Pampati VV, Falco FF. A randomized, double-blind, active-control trial of the effectiveness of lumbar interlaminar epidural injections in disc herniation. Pain Physician 17:E61-74, .
184. Manchikanti LL, Cash KK, Pampati VV, Wargo BB, Malla YY. Management of chronic pain of cervical disc herniation and radiculitis with fluoroscopic cervical interlaminar epidural injections. Int J Med Sci 9:424-34, .
185. Manchikanti LL, Singh VV, Cash KK, Pampati VV, Falco FF. The role of fluoroscopic interlaminar epidural injections in managing chronic pain of lumbar disc herniation or radiculitis: a randomized, double-blind trial. Pain Pract 13:547-58, .
186. Manchikanti LL, Singh VV, Cash KK, Pampati VV, Damron KK, Boswell MM. Effect of fluoroscopically guided caudal epidural steroid or local anesthetic injections in the treatment of lumbar disc herniation and radiculitis: a randomized, controlled, double blind trial with a two-year follow-up. Pain Physician 15:273-86, .
187. Ghai B, Kumar K, Bansal D, Dhatt SS, Kanukula R, Batra YK. Effectiveness of Parasagittal Interlaminar Epidural Local Anesthetic with or without Steroid in Chronic Lumbosacral Pain: A Randomized, Double-Blind Clinical Trial. Pain physician. 18(3):237-48, 2015 May-Jun.
188. Manchikanti LL, Cash KK, McManus CC, Pampati VV. Assessment of effectiveness of percutaneous adhesiolysis in managing chronic low back pain secondary to lumbar central spinal canal stenosis. Int J Med Sci 10:50-9, .
189. Manchikanti L, Singh V, Cash KA, Pampati V. Assessment of effectiveness of percutaneous adhesiolysis and caudal epidural injections in managing post lumbar surgery syndrome: 2-year follow-up of a randomized, controlled trial. Journal of pain research. 5:597-608, 2012.
190. North RR, Kidd DD, Petrucci LL, Dorsi MM. Spinal cord stimulation electrode design: a prospective, randomized, controlled trial comparing percutaneous with laminectomy electrodes: part II-clinical outcomes. Neurosurgery 57:990-6; discussion 990-6, .
191. Kumar KK, Taylor RR, Jacques LL, et al. Spinal cord stimulation versus conventional medical management for neuropathic pain: a multicentre randomised controlled trial in patients with failed back surgery syndrome. Pain 132:179-88, .
192. Bellini M, Barbieri M. Systemic effects of epidural steroid injections. Anaesthesiol Intensive Ther. 2013;45(2):93-8.
193. Abdi S, Datta S, Trescot AM, et al. Epidural steroids in the management of chronic spinal pain: a systematic review. Pain Physician. 2007 Jan;10(1):185-212.
194. McGrath JM, Schaefer MP, Malkamaki DM. Incidence and characteristics of complications from epidural steroid injections. Pain Med. 2011 May;12(5):726-31.
195. Schellhas KP, Pollei SR, Johnson BA, Golden MJ, Eklund JA, Pobiel RS. Selective cervical nerve root blockade: experience with a safe and reliable technique using an anterolateral approach for needle placement. AJNR Am J Neuroradiol. 2007;28(10):1909-14.
196. Pobiel RS, Schellhas KP, Eklund JA, et al. Selective cervical nerve root blockade: prospective study of immediate and longer term complications. AJNR Am J Neuroradiol. 2009 Mar;30(3):507-11.
197. Huston CW, Slipman CW, Garvin C. Complications and side effects of cervical and lumbosacral selective nerve root injections. Arch Phys Med Rehabil. 2005 Feb;86(2):277-83.
198. Ma DJ, Gilula LA, Riew KD. Complications of fluoroscopically guided extraforaminal cervical nerve blocks. An analysis of 1036 injections. J Bone Joint Surg Am. 2005 May;87(5):1025-30.
199. Trentman TL, Rosenfeld DM, Seamans DP, Hentz JG, Stanek JP. Vasovagal reactions and other complications of cervical vs. lumbar translaminar epidural steroid injections. Pain Pract. 2009;9(1):59-64.
200. Everett CR, Baskin MN, Speech D, Novoseletsky D, Patel R. Flushing as a side effect following lumbar transforaminal epidural steroid injection. Pain Physician. 2004 Oct;7(4):427-9.
201. Botwin KP, Gruber RD, Bouchlas CG, et al. Complications of fluoroscopically guided caudal epidural injections. Am J Phys Med Rehabil. 2001 Jun;80(6):416-24.
202. DeSio JM, Kahn CH, Warfield CA. Facial flushing and/or generalized erythema after epidural steroid injection. Anesth Analg. 1995 Mar;80(3):617-9.
203. Cicala RS, Westbrook L, Angel JJ. Side effects and complications of cervical epidural steroid injections. J Pain Symptom Manage. 1989 Jun;4(2):64-6.
204. Goldstein NN, McGuckin WW, McKenzie BB, Mattox VV. Experimental intrathecal administration of methylprednisolone acetate in multiple sclerosis. Trans Am Neurol Assoc 95:243-4, .
205. Nelson DD, Vates TT, Thomas RR. Complications from intrathecal steroid therapy in patients wsith multiple sclerosis. Acta Neurol Scand 49:176-88, .
206. Kotani NN, Kushikata TT, Hashimoto HH, et al. Intrathecal methylprednisolone for intractable postherpetic neuralgia. N Engl J Med 343:1514-9, .
207. Manchikanti L, Malla Y, Wargo BW, Cash KA, Pampati V, Fellows B. A prospective evaluation of complications of 10,000 fluoroscopically directed epidural injections. Pain physician. 15(2):131-40, 2012 Mar-Apr.
208. Manchikanti LL, Benyamin RR. Key safety considerations when administering epidural steroid injections. Pain Manag 5:261-72, .
209. Manchikanti LL, Hirsch JJ. Neurological complications associated with epidural steroid injections. Curr Pain Headache Rep 19:482, .
210. Matsui HH, Tsuji HH, Kanamori MM, Kawaguchi YY, Yudoh KK, Futatsuya RR. Laminectomy-induced arachnoradiculitis: a postoperative serial MRI study. Neuroradiology 37:660-6, .
211. Abhinav KK, Bradley MM, Aquilina KK, Patel NN. Spinal arachnoiditis and cyst formation with subarachnoid haemorrhage. Br J Neurosurg 26:574-5, .
212. Etchepare FF, Roche BB, Rozenberg SS, Dion EE, Bourgeois PP, Fautrel BB. Post-lumbar puncture arachnoiditis. The need for directed questioning. Joint Bone Spine 72:180-2, .
213. Food and Drug Administration. FDA briefing document: anesthetic and analgesic drug products advisory committee meeting. Available at: https://www.pharmamedtechbi.com/~/media/Supporting%20Documents/The%20Pink%20Sheet%20DAILY/2014/November/112114%20FDA%20edpidural%20adcom%20background.pdf.
214. Horlocker TT, Bajwa ZZ, Ashraf ZZ, et al. Risk assessment of hemorrhagic complications associated with nonsteroidal antiinflammatory medications in ambulatory pain clinic patients undergoing epidural steroid injection. Anesth Analg 95:1691-7, table of contents, .
215. Shah RR, Kaye AA. Bleeding risk and interventional pain management. Curr Opin Anaesthesiol 21:433-8, .
216. Gustafsson HH, Rutberg HH, Bengtsson MM. Spinal haematoma following epidural analgesia. Report of a patient with ankylosing spondylitis and a bleeding diathesis. Anaesthesia 43:220-2, .
217. Endres SS, Shufelt AA, Bogduk NN. The Risks of Continuing or Discontinuing Anticoagulants for Patients Undergoing Common Interventional Pain Procedures. Pain Med 18:403-409, .
218. Goodman BB, House LL, Vallabhaneni SS, Mallempati SS, Willey MM, Smith MM. Anticoagulant and Antiplatelet Management for Spinal Procedures: A Prospective, Descriptive Study and Interpretation of Guidelines. Pain Med 18:1218-1224, .
219. Reitman CC, Watters WW. Subdural hematoma after cervical epidural steroid injection. Spine (Phila Pa 1976) 27:E174-6, .
220. Ain RR, Vance MM. Epidural hematoma after epidural steroid injection in a patient withholding enoxaparin per guidelines. Anesthesiology 102:701-3, .
221. Benyamin RR, Vallejo RR, Wang VV, Kumar NN, Cedeño DD, Tamrazi AA. Acute Epidural Hematoma Formation in Cervical Spine After Interlaminar Epidural Steroid Injection Despite Discontinuation of Clopidogrel. Reg Anesth Pain Med 41:398-401, .
222. Benzon HH, Wong HH, Siddiqui TT, Ondra SS. Caution in performing epidural injections in patients on several antiplatelet drugs. Anesthesiology 91:1558-9, .
223. Loomba VV, Kaveeshvar HH, Dwivedi SS. Paraplegia After Thoracic Epidural Steroid Injection. A A Case Rep 7:118-21, .
224. Page JJ, Moisi MM, Oskouian RR. Lumbar Epidural Hematoma Following Interlaminar Fluoroscopically Guided Epidural Steroid Injection. Reg Anesth Pain Med 41:402-4, .
225. Xu RR, Bydon MM, Gokaslan ZZ, Wolinsky JJ, Witham TT, Bydon AA. Epidural steroid injection resulting in epidural hematoma in a patient despite strict adherence to anticoagulation guidelines. J Neurosurg Spine 11:358-64, .
226. Kövesi TT, Royston DD. Is there a bleeding problem with platelet-active drugs?. Br J Anaesth 88:159-63, .
227. Rozin LL, Rozin RR, Koehler SS, et al. Death during transforaminal epidural steroid nerve root block (C7) due to perforation of the left vertebral artery. Am J Forensic Med Pathol 24:351-5, .
228. Wallace MM, Fukui MM, Williams RR, Ku AA, Baghai PP. Complications of cervical selective nerve root blocks performed with fluoroscopic guidance. AJR Am J Roentgenol 188:1218-21, .
229. Ziai WW, Ardelt AA, Llinas RR. Brainstem stroke following uncomplicated cervical epidural steroid injection. Arch Neurol 63:1643-6, .
230. Craig DD, Habib GG. Flaccid paraparesis following obstetrical epidural anesthesia: possible role of benzyl alcohol. Anesth Analg 56:219-21, .
231. Feasby TT, Hahn AA, Gilbert JJ. Neurotoxicity of bacteriostatic water. N Engl J Med 308:966-7, .
232. Hahn AA, Feasby TT, Gilbert JJ. Paraparesis following intrathecal chemotherapy. Neurology 33:1032-8, .
233. Hetherington NN, Dooley MM. Potential for patient harm from intrathecal administration of preserved solutions. Med J Aust 173:141-3, .
234. Chiluka VL, Banji D, Banji OJF, Sollu M, Pandra SB. Glucocorticoid induced osteoporosis. Intern J Pharm Sci Rev 2010;53:124-31.
235. Kang SS, Hwang BB, Son HH, Cheong II, Lee SS, Chung TT. Changes in bone mineral density in postmenopausal women treated with epidural steroid injections for lower back pain. Pain Physician 15:229-36, .
236. Kim SS, Hwang BB. Relationship between bone mineral density and the frequent administration of epidural steroid injections in postmenopausal women with low back pain. Pain Res Manag 19:30-4, .
237. Yi YY, Hwang BB, Son HH, Cheong II. Low bone mineral density, but not epidural steroid injection, is associated with fracture in postmenopausal women with low back pain. Pain Physician 15:441-9, .
238. Bouvard B, Legrand E, Audran M, Chappard D. Glucocorticoid-induced osteoporosis: A review. Clin Rev Bone Miner Metab 2010;8:15-26.
239. van Staa TT, Leufkens HH, Cooper CC. The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis. Osteoporos Int 13:777-87, .
240. Mandel SS, Schilling JJ, Peterson EE, Rao DD, Sanders WW. A retrospective analysis of vertebral body fractures following epidural steroid injections. J Bone Joint Surg Am 95:961-4, .
241. Carreon LL, Ong KK, Lau EE, Kurtz SS, Glassman SS. Risk of Osteoporotic Fracture After Steroid Injections in Patients With Medicare. Am J Orthop (Belle Mead NJ) 46:E293-E300, .
242. Even JJ, Crosby CC, Song YY, McGirt MM, Devin CC. Effects of epidural steroid injections on blood glucose levels in patients with diabetes mellitus. Spine (Phila Pa 1976) 37:E46-50, .
243. Gonzalez PP, Laker SS, Sullivan WW, Harwood JJ, Akuthota VV. The effects of epidural betamethasone on blood glucose in patients with diabetes mellitus. PM R 1:340-5, .
244. Zufferey PP, Bulliard CC, Gremion GG, Saugy MM, So AA. Systemic effects of epidural methylprednisolone injection on glucose tolerance in diabetic patients. BMC Res Notes 4:552, .
245. Botwin KK, Gruber RR. Lumbar epidural steroid injections in the patient with lumbar spinal stenosis. Phys Med Rehabil Clin N Am 14:121-41, .
246. Younes MM, Neffati FF, Touzi MM, et al. Systemic effects of epidural and intra-articular glucocorticoid injections in diabetic and non-diabetic patients. Joint Bone Spine 74:472-6, .
247. Millefert JF, Aho S, Huguenin MC. Systemic effects of epidural dexamethasone injections. Rev Rhum Engl Ed 1995;62:429-32.
248. Hsu D, Fu P, Gyermek L, Tan C. Comparison of plasma cortisol and ACTH profile after a single lumbar epidural dose of triamcinolone 40 mg, 80 mg respectively in low back pain patients. Anesthesia and analgesia 1996;82:S191.
249. Camacho M, Mugnier B, Foutrier MC, Roux H. Glucocorticoid induced spinal epidural lipomatosis. Rev Rhum Ed Fr 2001:648-53.
250. Danielson KK, Harrast MM. Focal spinal epidural lipomatosis after a single epidural steroid injection. PM R 3:590-3, .
251. Fessler RR, Johnson DD, Brown FF, Erickson RR, Reid SS, Kranzler LL. Epidural lipomatosis in steroid-treated patients. Spine (Phila Pa 1976) 17:183-8, .
252. Koch CC, Doppman JJ, Patronas NN, Nieman LL, Chrousos GG. Do glucocorticoids cause spinal epidural lipomatosis? When endocrinology and spinal surgery meet. Trends Endocrinol Metab 11:86-90, .
253. Möller JJ, Girschick HH, Hahn GG, Pessler FF. [Steroid-induced spinal epidural lipomatosis in pediatric patients]. Z Rheumatol 69:447-9, .
254. Russell NN, Belanger GG, Benoit BB, Latter DD, Finestone DD, Armstrong GG. Spinal epidural lipomatosis: a complication of glucocorticoid therapy. Can J Neurol Sci 11:383-6, .
255. Brill SS, Swartz AA, Brill GG. Epidural steroid injections do not induce weight gain. Curr Drug Saf 2:113-6, .

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