epidural injections


Summary: The injection of drugs, most often analgesics, into the spinal canal without puncturing the dura mater.

Top Publications

  1. Stanczak J, Blankenbaker D, De Smet A, Fine J. Efficacy of epidural injections of Kenalog and Celestone in the treatment of lower back pain. AJR Am J Roentgenol. 2003;181:1255-8 pubmed
  2. Bronfort G, Evans R, Maiers M, Anderson A. Spinal manipulation, epidural injections, and self-care for sciatica: a pilot study for a randomized clinical trial. J Manipulative Physiol Ther. 2004;27:503-8 pubmed
    ..The results of this pilot study suggest that it is feasible to recruit subacute and chronic sciatica patients and to obtain their compliance for a full-scale randomized clinical. ..
  3. Wagner A. CT fluoroscopy-guided epidural injections: technique and results. AJNR Am J Neuroradiol. 2004;25:1821-3 pubmed
    Lumbar epidural injections are typically performed blindly or with fluoroscopic guidance...
  4. Lee J, Kim S, Choi J, Yeom J, Kim K, Chung S, et al. Transforaminal epidural steroid injection for lumbosacral radiculopathy: preganglionic versus conventional approach. Korean J Radiol. 2006;7:139-44 pubmed
  5. Furman M, Mehta A, Kim R, Simon J, Patel R, Lee T, et al. Injectate volumes needed to reach specific landmarks in lumbar transforaminal epidural injections. PM R. 2010;2:625-35 pubmed publisher
    To identify the volumes of contrast material needed to reach specific landmarks during lumbar transforaminal epidural injections (L-TFEIs). Prospective, nonrandomized, observational human study. Academic/private pain management practice...
  6. Makki D, Nawabi D, Francis R, Hamed A, Hussein A. Is the outcome of caudal epidural injections affected by patient positioning?. Spine (Phila Pa 1976). 2010;35:E687-90 pubmed publisher
    ..Caudal epidural injections are used widely in the treatment of low back pain and radicular leg pain...
  7. Manchikanti L, Pampati V, Boswell M, Smith H, Hirsch J. Analysis of the growth of epidural injections and costs in the Medicare population: a comparative evaluation of 1997, 2002, and 2006 data. Pain Physician. 2010;13:199-212 pubmed
    ..b>Epidural injections and facet joint interventions are the 2 most commonly utilized procedures in interventional pain management...
  8. Smuck M, Fuller B, Yoder B, Huerta J. Incidence of simultaneous epidural and vascular injection during lumbosacral transforaminal epidural injections. Spine J. 2007;7:79-82 pubmed
    ..of vascular penetration during contrast confirmed fluoroscopically guided transforaminal lumbosacral epidural injections has been reported as 8.9% to 21.3% depending on the level of injection...
  9. Goodman B, Bayazitoglu M, Mallempati S, Noble B, Geffen J. Dural puncture and subdural injection: a complication of lumbar transforaminal epidural injections. Pain Physician. 2007;10:697-705 pubmed
    ..The hazard of dural puncture during transforaminal epidural injections, the anatomy of the dural and thecal sac, the potential for subdural injections, and relevant literature ..

More Information


  1. Lew H, Coelho P, Chou L. Preganglionic approach to transforaminal epidural steroid injections. Am J Phys Med Rehabil. 2004;83:378 pubmed
  2. Smuck M, Fuller B, Chiodo A, Benny B, Singaracharlu B, Tong H, et al. Accuracy of intermittent fluoroscopy to detect intravascular injection during transforaminal epidural injections. Spine (Phila Pa 1976). 2008;33:E205-10 pubmed publisher
    ..Serious morbidity caused by transforaminal epidural injections is frequently related to inadvertent vascular injection of corticosteroids...
  3. Manchikanti L, Singh V, Cash K, Pampati V, Datta S. Preliminary results of a randomized, equivalence trial of fluoroscopic caudal epidural injections in managing chronic low back pain: Part 3--Post surgery syndrome. Pain Physician. 2008;11:817-31 pubmed
    ..b>Epidural injections are most commonly used in post surgery syndrome...
  4. Manchikanti L, Cash K, McManus C, Pampati V, Smith H. Preliminary results of a randomized, equivalence trial of fluoroscopic caudal epidural injections in managing chronic low back pain: Part 1--Discogenic pain without disc herniation or radiculitis. Pain Physician. 2008;11:785-800 pubmed
    ..Even though epidural injections are frequently administered in managing axial low back pain, the evidence is lacking...
  5. Liphofer J, Theodoridis T, Becker G, Koester O, Schmid G. [(Modic) signal alterations of vertebral endplates and their correlation to a minimally invasive treatment of lumbar disc herniation using epidural injections]. Rofo. 2006;178:1105-14 pubmed
    ..endplate (CEP) of vertebrae L3-S1 on the outcome of an in-patient minimally invasive treatment (MIT) using epidural injections on patients with lumbar disc herniation (LDH)...
  6. Schaufele M, Hatch L, Jones W. Interlaminar versus transforaminal epidural injections for the treatment of symptomatic lumbar intervertebral disc herniations. Pain Physician. 2006;9:361-6 pubmed
    ..Transforaminal epidural injections are believed to produce better clinical outcomes than interlaminar epidural injections...
  7. Schmid G, Schmitz A, Borchardt D, Ewen K, von Rothenburg T, Koester O, et al. Effective dose of CT- and fluoroscopy-guided perineural/epidural injections of the lumbar spine: a comparative study. Cardiovasc Intervent Radiol. 2006;29:84-91 pubmed
    The objective of this study was to compare the effective radiation dose of perineural and epidural injections of the lumbar spine under computed tomography (CT) or fluoroscopic guidance with respect to dose-reduced protocols...
  8. Derby R, Lee S, Date E, Lee J, Lee C. Size and aggregation of corticosteroids used for epidural injections. Pain Med. 2008;9:227-34 pubmed publisher
    ..Until shown otherwise in clinical studies, interventionalists might consider using dexamethasone or another corticosteroid preparation with similar high solubility and negligible particle size when performing epidural injections.
  9. Huntoon M. Anatomy of the cervical intervertebral foramina: vulnerable arteries and ischemic neurologic injuries after transforaminal epidural injections. Pain. 2005;117:104-11 pubmed
    ..Critical arteries are located in the posterior aspect of the intervertebral foramen and may be vulnerable to injection or injury during transforaminal epidural steroid injection. ..
  10. Manchikanti L, Singh V, Cash K, Pampati V, Damron K, Boswell M. Preliminary results of a randomized, equivalence trial of fluoroscopic caudal epidural injections in managing chronic low back pain: Part 2--Disc herniation and radiculitis. Pain Physician. 2008;11:801-15 pubmed
    ..The prevalence of sciatica or radiculitis ranges from 1.2% to 43%. Epidural injections are one of the most commonly performed interventions in the United States in managing chronic low back and ..
  11. Manchikanti L, Cash K, McManus C, Pampati V, Abdi S. Preliminary results of a randomized, equivalence trial of fluoroscopic caudal epidural injections in managing chronic low back pain: Part 4--Spinal stenosis. Pain Physician. 2008;11:833-48 pubmed
    ..the United States, one of the most commonly performed interventions for managing chronic low back pain are epidural injections, including their use for spinal stenosis...
  12. Kim K, Shin S, Kim T, Jeong C, Yoon M, Choi J. Fluoroscopically guided cervical interlaminar epidural injections using the midline approach: an analysis of epidurography contrast patterns. Anesth Analg. 2009;108:1658-61 pubmed publisher
    ..this study was to evaluate epidurography contrast patterns in fluoroscopically guided cervical interlaminar epidural injections using the midline approach. All epidural injections were performed at the C6-7 level in the prone position...
  13. Sayegh F, Kenanidis E, Papavasiliou K, Potoupnis M, Kirkos J, Kapetanos G. Efficacy of steroid and nonsteroid caudal epidural injections for low back pain and sciatica: a prospective, randomized, double-blind clinical trial. Spine (Phila Pa 1976). 2009;34:1441-7 pubmed publisher
    ..Prospective, double-blind, randomized, case-control study...
  14. Kim D, Han K, Kim C, Chae Y. Intravascular flow patterns in transforaminal epidural injections: a comparative study of the cervical and lumbar vertebral segments. Anesth Analg. 2009;109:233-9 pubmed publisher
    ..This finding suggests the need for a proper volume of contrast injection (3 mL) to detect vascular flow, especially in simultaneous perineural and vascular injections. ..
  15. Manchikanti L, Cash K, McManus C, Pampati V, Singh V, Benyamin R. The preliminary results of a comparative effectiveness evaluation of adhesiolysis and caudal epidural injections in managing chronic low back pain secondary to spinal stenosis: a randomized, equivalence controlled trial. Pain Physician. 2009;12:E341-54 pubmed
    Lumbar surgery and epidural injections for spinal stenosis are the most commonly performed interventions in the United States. However, there is only moderate evidence to the effectiveness of surgery and caudal epidural injections...
  16. Chen C, Wong A, Hsu C, Tsai W, Chang C, Lin S, et al. Ultrasound as a screening tool for proceeding with caudal epidural injections. Arch Phys Med Rehabil. 2010;91:358-63 pubmed publisher
    ..The mean distance between bilateral cornua was measured to be 9.7+/-1.9 mm. Caudal epidural injections failed in 7 patients. In these 7 patients, 4 had very small diameter of the sacral canal (1.6, 1.2, 1...
  17. Manchikanti L, Cash K, Pampati V, Wargo B, Malla Y. The effectiveness of fluoroscopic cervical interlaminar epidural injections in managing chronic cervical disc herniation and radiculitis: preliminary results of a randomized, double-blind, controlled trial. Pain Physician. 2010;13:223-36 pubmed
    ..Cervical epidural injections for managing chronic neck pain with disc herniation are one of the commonly performed non-surgical ..
  18. Wilson MacDonald J, Burt G, Griffin D, Glynn C. Epidural steroid injection for nerve root compression. A randomised, controlled trial. J Bone Joint Surg Br. 2005;87:352-5 pubmed
    ..There was a significant reduction in pain early on in those having an epidural steroid injection but no difference in the long term between the two groups. The rate of subsequent operation in the groups was similar. ..
  19. Vad V, Bhat A, Lutz G, Cammisa F. Transforaminal epidural steroid injections in lumbosacral radiculopathy: a prospective randomized study. Spine (Phila Pa 1976). 2002;27:11-6 pubmed
    ..005). Fluoroscopically guided transforaminal injections serve as an important tool in the nonsurgical management of lumbosacral radiculopathy secondary to a herniated nucleus pulposus. ..
  20. Bush K, Hillier S. A controlled study of caudal epidural injections of triamcinolone plus procaine for the management of intractable sciatica. Spine (Phila Pa 1976). 1991;16:572-5 pubmed
    ..This preliminary study assesses the efficacy of epidural injections of 80 mg triamcinolone acetonide plus 0...
  21. Wang J, Lin E, Brodke D, Youssef J. Epidural injections for the treatment of symptomatic lumbar herniated discs. J Spinal Disord Tech. 2002;15:269-72 pubmed
    ..Patients treated with injections may be able to avoid surgical treatment up to this period and perhaps even longer. ..
  22. Botwin K, Castellanos R, Rao S, Hanna A, Torres Ramos F, Gruber R, et al. Complications of fluoroscopically guided interlaminar cervical epidural injections. Arch Phys Med Rehabil. 2003;84:627-33 pubmed
    To assess the incidence of complications of fluoroscopically guided interlaminar cervical epidural injections. A retrospective cohort design study. A multidisciplinary spine care center...
  23. Yue W, Tan S. Distant skip level discitis and vertebral osteomyelitis after caudal epidural injection: a case report of a rare complication of epidural injections. Spine (Phila Pa 1976). 2003;28:E209-11 pubmed
    ..A case report of distant discitis and vertebral osteomyelitis involving skip levels after caudal epidural steroid injection...
  24. Lieberman R, Dreyfuss P, Baker R. Fluoroscopically guided interlaminar cervical epidural injections. Arch Phys Med Rehabil. 2003;84:1568-9; author reply 1569 pubmed
  25. Thomas E, Cyteval C, Abiad L, Picot M, Taourel P, Blotman F. Efficacy of transforaminal versus interspinous corticosteroid injectionin discal radiculalgia - a prospective, randomised, double-blind study. Clin Rheumatol. 2003;22:299-304 pubmed
    ..In recent discal radiculalgia, the efficacy of radio-guided transforaminal epidural corticosteroid injections was higher than that obtained with blindly-performed interspinous injections. ..
  26. Gomez de Segura I, Menafro A, García Fernández P, Murillo S, Parodi E. Analgesic and motor-blocking action of epidurally administered levobupivacaine or bupivacaine in the conscious dog. Vet Anaesth Analg. 2009;36:485-94 pubmed publisher
    ..Epidural levobupivacaine produced an analgesic action similar to that of bupivacaine. Epidural levobupivacaine is suitable for clinical use in dogs, mostly at the highest dose if a high degree of analgesia is required. ..
  27. Tripathi M, Nath S, Gupta R. Paraplegia after intracord injection during attempted epidural steroid injection in an awake-patient. Anesth Analg. 2005;101:1209-11, table of contents pubmed
    ..Intracord injection of triamcinolone acetate and local anesthetic, resulting in permanent paraplegia, may occur in conscious patients. ..
  28. Volchkov V, Boikova N, Tomson V. [Local neurotoxicity of isobaric 2% solution of lidocaine at epidural administration]. Vestn Khir Im I I Grek. 2004;163:95-9 pubmed
    ..changes were found to vary within the physiological fluctuation limits and are rather indicative of the functional reaction of the nervous tissue structures in question to the epidural injections of either saline or lidocaine.
  29. Sekar C, Rajasekaran S, Kannan R, Reddy S, Shetty T, Pithwa Y. Preemptive analgesia for postoperative pain relief in lumbosacral spine surgeries: a randomized controlled trial. Spine J. 2004;4:261-4 pubmed
    ..Preemptive analgesia with a single caudal epidural injection of bupivacaine and tramadol is a safe, simple and effective method for postoperative pain relief. ..
  30. Pandin P, Haentjens L, Salengros J, Quintin J, Barvais L. Combined ultrasound and nerve stimulation-guided thoracic epidural catheter placement for analgesia following anterior spine fusion in scoliosis. Pain Pract. 2009;9:230-4 pubmed publisher
    ..The combination of US and nerve stimulation in this setting may be associated with easier, potentially safer, and more accurate insertion. ..
  31. Iff I, Larenza M, Moens Y. The extradural pressure profile in goats following extradural injection. Vet Anaesth Analg. 2009;36:180-5 pubmed publisher
    ..2 mL kg(-1) may be indicative of correct placement but even here we saw one of nine animals with extradural pressure waves where we failed to confirm correct needle placement. Extradural pressure increases after extradural injection. ..
  32. Mikhael M, Bach H, Huddleston P, Maus T, Berbari E. Multilevel diskitis and vertebral osteomyelitis after diskography. Orthopedics. 2009;32:60 pubmed
    ..This case demonstrates that early changes on MRI should warrant immediate workup and treatment. Treatment involves at least 6 weeks of parenteral antimicrobial therapy. ..
  33. Ludvig N, Kuzniecky R, Baptiste S, John J, von Gizycki H, Doyle W, et al. Epidural pentobarbital delivery can prevent locally induced neocortical seizures in rats: the prospect of transmeningeal pharmacotherapy for intractable focal epilepsy. Epilepsia. 2006;47:1792-802 pubmed
    ..The findings support the viability of transmeningeal pharmacotherapy for the treatment of intractable neocortical epilepsy. ..
  34. Nash T. Epiduroscopy for lumbar spinal stenosis. Br J Anaesth. 2005;94:250; author reply 250-1 pubmed
  35. Kanai A, Suzuki A, Hoka S. Rapid injection of epidural mepivacaine speeds the onset of nerve blockade. Can J Anaesth. 2005;52:281-4 pubmed
    ..Rapid injection of mepivacaine in the epidural space produced a more rapid onset of epidural block than slow injection, but there was no difference in the final extent of the block. ..
  36. Birkenmaier C, Leu H, Veihelmann A. Re: Becker C, Heidersdorf S, Drewlo S, et al. Efficacy of epidural perineural injections with autologous conditioned serum for lumbar radicular compression. Spine 2007;32:1803-8. Spine (Phila Pa 1976). 2008;33:576 pubmed publisher
  37. Akin A, Ocalan S, Esmaoglu A, Boyaci A. The effects of caudal or intravenous clonidine on postoperative analgesia produced by caudal levobupivacaine in children. Paediatr Anaesth. 2010;20:350-5 pubmed publisher
    ..05). Caudal clonidine prolongs the duration of analgesia produced by caudal levobupivacaine without causing significant side effects and this is because of a spinal mode of action. ..
  38. Hatton K, Atallah J. A simple model for epidural needle placement. Anesth Analg. 2007;104:468-9 pubmed
  39. Chaudhri B, Macfie A, Kirk A. Inadvertent total spinal anesthesia after intercostal nerve block placement during lung resection. Ann Thorac Surg. 2009;88:283-4 pubmed publisher
    ..The patient required postoperative ventilation until the neurologic deficits resolved. The operator must be aware that intercostal nerve block runs the rare but potentially fatal risk of total spinal block. ..
  40. Eckel T, Bartynski W. Epidural steroid injections and selective nerve root blocks. Tech Vasc Interv Radiol. 2009;12:11-21 pubmed publisher
    ..While the basic technical approach to epidural steroid administration in the cervical, thoracic, and lumbar regions is similar, each region has unique issues that must be addressed. ..
  41. Iff I, Mosing M, Lechner T, Moens Y. The use of an acoustic device to identify the extradural space in standing horses. Vet Anaesth Analg. 2010;37:57-62 pubmed publisher
    ..8 kPa (-6 mmHg). The acoustic device is useful to assist in the identification of successful or unsuccessful extradural needle placement in the horse. ..
  42. Rapp H, Molnar V, Austin S, Krohn S, Gädeke V, Motsch J, et al. Ropivacaine in neonates and infants: a population pharmacokinetic evaluation following single caudal block. Paediatr Anaesth. 2004;14:724-32 pubmed
    ..The postoperative pain management provided adequate analgesia and was well tolerated. ..
  43. Hooten W, Kinney M, Huntoon M. Epidural abscess and meningitis after epidural corticosteroid injection. Mayo Clin Proc. 2004;79:682-6 pubmed
    ..aureus. Antibiotic prophylaxis for S. aureus should be considered for immunocompromised patients undergoing epidural corticosteroid injections. ..
  44. Boikova N, Volchkov V, Strashnov V, Tomson V. Morphofunctional changes in spinal cord neurons after epidural lidocaine. Neurosci Behav Physiol. 2004;34:597-601 pubmed
    ..The changes recorded varied within the limits of physiological variation and provided evidence predominantly of the functional response of these nerve tissue structures to epidural injections of both sodium chloride and lidocaine.
  45. Lasbleiz J, Siegfried D, Chales G, Marin F, Sighetti M, Duvauferrier R. [Evaluation of CT guided cervical epidural injections in patients with mechanical cervicobrachial neuralgia]. J Radiol. 2008;89:317-23 pubmed
    Prospective study evaluating the efficacy and tolerability of CT guided cervical epidural injections for mechanical cervicobrachial neuralgia.
  46. Konakci S, Adanir T, Yilmaz G, Rezanko T. The efficacy and neurotoxicity of dexmedetomidine administered via the epidural route. Eur J Anaesthesiol. 2008;25:403-9 pubmed
    ..035). We observed that dexmedetomidine does not have motor and sensory effects, but it may have a harmful effect on the myelin sheath when administered via the epidural route. ..
  47. Provenzano D, Fanciullo G. Cervical transforaminal epidural steroid injections: should we be performing them?. Reg Anesth Pain Med. 2007;32:168; author reply 169-70 pubmed
  48. Owlia M, Salimzadeh A, Alishiri G, Haghighi A. Comparison of two doses of corticosteroid in epidural steroid injection for lumbar radicular pain. Singapore Med J. 2007;48:241-5 pubmed
    ..Many clinicians use 80 mg long-acting glucocorticoids in epidural steroid injections (ESI). The aim of this study is to compare the clinical response of 80 mg versus 40 mg methylprednisolone in ESI...
  49. Huang S, Wang C, Chang W, Chan K, Chu C. Intravenous propofol precipitates the hypotension induced by inadvertent epidural thiopental injection. Acta Anaesthesiol Taiwan. 2006;44:239-42 pubmed
    ..Attempts to forestall neurological sequela after the inadvertence seem unnecessary unless apparent symptoms or signs of neurological injury have come upon. ..
  50. Wolff A, Groen G, Wilder Smith O. Influence of needle position on lumbar segmental nerve root block selectivity. Reg Anesth Pain Med. 2006;31:523-30 pubmed
    ..The variability in anatomic position of the dorsal root ganglion necessitates electrostimulation to guide SNRB in addition to fluoroscopy. ..
  51. Akkaya T, Sayin M. [Transforaminal epidural steroid injection and its complications]. Agri. 2005;17:27-39 pubmed
    ..In this review, transforaminal epidural steroid injection techniques and their complications are examined. ..
  52. Shakir A, Kimbrough D, Mehta B. Postherpetic neuralgia involving the right C5 dermatome treated with a cervical transforaminal epidural steroid injection: a case report. Arch Phys Med Rehabil. 2007;88:255-8 pubmed
    ..In this case, the use of a cervical TESI provided dramatic results in the treatment of debilitating postherpetic neuralgia (PHN). Further investigation is needed to determine the efficacy of TESI in the early management of PHN. ..
  53. Huntoon M. Back pain: more to the story. Minn Med. 2006;89:6, 8; discussion 8 pubmed