This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (25) Citing Articles via Google Scholar Google Scholar Articles by Cluff, R. Articles by Stojanovic, M. P. Search for Related Content PubMed PubMed Citation Articles by Cluff, R. Articles by Stojanovic, M. P. Related Collections Regional Anesthesia Pain

---

PAIN MEDICINE

The Technical Aspects of Epidural Steroid Injections: A National Survey

Robert Cluff, MD, Abdel-Kader Mehio, MD, Steven P. Cohen, MD, Yuchiao Chang, PhD, Christine N. Sang, MD MPH^*, and Milan P. Stojanovic, MD^*

*Clinical Trials Program and Interventional Pain Program, MGH Pain Center; and Department of Anesthesia and Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts

Address correspondence and reprint requests to Milan Stojanovic, MD, MGH Pain Center, ACC-324, Massachusetts General Hospital, Fruit St., Boston, MA 02114. Address e-mail to mstojanovic{at}partners.org

Although epidural steroid injections (ESIs) are a common treatment for chronic pain conditions, it is not clear whether there is consensus on their technical aspects. The current literature suggests that variations in technical aspects may affect ESI outcomes. The goal of the survey was to help establish a standard frame of reference for the performance of ESIs. We analyzed survey results from 68 academic anesthesia programs and 28 private practices in the United States. The main finding in this survey is that there is no clear-cut consensus as to the ideal method to perform ESI. There is a wide variation among individual practices in almost every technical aspect of ESI. Private practices use significantly more fluoroscopy than academic centers. The large difference was found in the cervical region where 73% of private practices and only 39% of academic institutions polled perform the ESIs with fluoroscopic guidance (P = 0.005). A similar discrepancy was found in approaches to the epidural space after laminectomy where 61% of private practices, but only 15% of academic centers, use the transforaminal approach. The study results indicate that there is no consensus, and that there is a wide variation in current practices.

IMPLICATIONS: A national survey of practices performing epidural steroid injections was conducted. The purpose was to establish whether consensus exists on technical aspects of this procedure. The study results indicate that there is no consensus, and that there is a wide variation in current practices.

This article has been cited by other articles:

				T. Wolter, M. Mohadjer, A. Berlis, and S. Knoeller Cervical CT-Guided, Selective Nerve Root Blocks: Improved Safety by Dorsal Approach AJNR Am. J. Neuroradiol., February 1, 2009; 30(2): 336 - 337. [Abstract] [Full Text] [PDF]

				H. S. Jeong, J. W. Lee, S. H. Kim, J. S. Myung, J. H. Kim, and H. S. Kang Effectiveness of Transforaminal Epidural Steroid Injection by Using a Preganglionic Approach: A Prospective Randomized Controlled Study Radiology, November 1, 2007; 245(2): 584 - 590. [Abstract] [Full Text] [PDF]

				I. A. Young, G. S. Hyman, L. N. Packia-Raj, and A. J. Cole The Use of Lumbar Epidural/Transforaminal Steroids for Managing Spinal Disease J. Am. Acad. Ortho. Surg., April 1, 2007; 15(4): 228 - 238. [Abstract] [Full Text] [PDF]

				D. G. Merrill, J. P. Rathmell, J. C. Rowlingson, M. P. Stojanovic, C. N. Sang, and S. P. Cohen Epidural Steroid Injections * Response Anesth. Analg., March 1, 2003; 96(3): 907 - 908. [Full Text] [PDF]