Transfacet epidural steroid injection

Intercostal neuralgia is the most common complication following endoscopic transthoracic anterior surgery for a herniated disk.

In the cited study the authors address the surgical strategies required to resect residual herniated thoracic discs. Endoscopic surgery requires establishment of portals between the ribs and frequently causes compression of the intercostal nerves. Therefore, the most common complication is intercostal neuralgia. Pneumothorax and cardiac tamponade are extremely rare.

Stillerman et al present a review of 71 patients with 82 herniated thoracic discs that underwent transthoracic, transfacet pedicle-sparing, lateral extracavitary, or transpedicular approaches for removal of the herniation.

This study was designed to investigate radiation exposure to a physician performing fluoroscopically guided caudal epidural steroid injections. The prospective study design included 100 consecutive fluoroscopically guided caudal epidural steroid injections performed on patients with radiculitis from either herniated nucleus pulposus or lumbar spinal stenosis. Radiation exposure was monitored with the assistance of a radiological technologist (RT) who allocated four dosimetry badges to all physicians performing fluoroscopically guided caudal epidural steroid injections on consecutive patients being treated for radicular pain. The badges were placed on the ring finger, glasses and both the inside and outside of the lead apron worn by the physician. In addition, the RTs also wore a marked badge outside his/her lead apron. A control badge was placed 67 inches away from the fluoroscopy table, and a second control badge was located in a desk over 500 feet away from the procedure, to monitor ambient radiation. The average fluoroscopy time per procedure was seconds. The average/cumulative exposure per procedure was /410 mREM at the “ring” badge, /247 mREM at the “glasses” badge, /398 mREM at the “outside apron” badge and /15 mREM at the “inside” apron; no radiation was detectable at the “outside room” control badge. The RT’s average exposure during these procedures was below the limit of detectability. Radiation exposure to the physician needs to be considered and minimized in the performance of spinal interventional procedures. Our study demonstrates that radiation exposure to the physician performing fluoroscopically guided caudal epidural steroid injections is well within safety limits when he/she adheres to proper technique.

Early and medium-term clinical results with the Charité III for the treatment of low-back pain from degenerative disc disease (DDD) have been encouraging. 12 Review of these results led to its approval as the first TDR for general use in the United States by the FDA, in 2004, as an alternative to lumbar fusion. Though not statistically different, results in the Charité patients tended to be better in this highly select group. Complication rates were similar in the TDR and fusion groups. Long-term results are available from Europe. With a minimum follow-up of 10 years, Lemaire et al 13 and David 14 reported good or excellent clinical outcomes in 90% of patients. Furthermore, they showed a mean of ° of motion in flexion-extension at follow-up. Clinical failures of the Charité III have been reported recently. 10 , 15 Most of these failures could be linked to the application of the artificial disc in what is considered a contraindication in the FDA investigational device exemption (IDE) study.

What are the risks and side effects of facet injections?
Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects and possibility of complications. The most common side effect is pain; which is temporary. The other risks involve, infection, bleeding, worsening of symptoms, spinal block, Epidural block etc. The other risks are related to the side effects of cortisone: These include weight gain, increase in blood sugar (mainly in diabetics), water retention, suppression of body's own natural production of cortisone etc. Fortunately, the serious side effects and complications are uncommon.

Transfacet epidural steroid injection

transfacet epidural steroid injection

What are the risks and side effects of facet injections?
Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects and possibility of complications. The most common side effect is pain; which is temporary. The other risks involve, infection, bleeding, worsening of symptoms, spinal block, Epidural block etc. The other risks are related to the side effects of cortisone: These include weight gain, increase in blood sugar (mainly in diabetics), water retention, suppression of body's own natural production of cortisone etc. Fortunately, the serious side effects and complications are uncommon.

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