Lumbar Epidural Steroids Injections, Pearls and Pitfalls

Introduction

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Epidural steroid injections are the most performed procedure to treat back pain. It is proven to be effective in many studies and is performed by many specialties. The anesthesiologist usually does the interlaminar landmark-based technique while the pain specialist does it using fluoroscopy/CT guidance. All types of epidural injections (interlaminar, transforaminal, and caudal) are discussed in detail including specific indications, complications, and techniques.

Objectives

By the end of this lecture, the learner will be able to:
- Decide if epidural steroid injection is effective?
- Understand the difference between the 3 epidural approaches
- Recognize the specific indication/complication of each approach
- Predict the ideal solution?
- Determine when to use particulate or non-particulate steroids!?
- Describe the ideal frequency of injections?
- Define the maximum per year?

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