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2000 SAE-P: Lumbosacral epidural steroid injections answer key and commentary on preferred choice
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2000 SAE-P: Lumbosacral Epidural Steroid Injections Answer Key And Commentary on Preferred Choice QUESTION
ANSWER
COMMENTARY
1.
(d)
2.
(c)
3.
(a)
4.
(a)
5.
(d)
The presence of nerve root compression is not sufficient to cause radicular pain, as relief of pressure does not always result in pain relief, while the persistence of pressure does not always result in continued pain. There is evidence that an inflammatory response involving phospholipase A (and possibly also prostaglandins and leukotrienes) is responsible for mediating the radicular pain response. Foraminal injections at the level of the disc pathology on the symptomatic side is recommended for lateral or foraminal disc herniations. Caudal injections are only optimal for pathology at the L5-S 1 disc because sufficient cephalad spread may not occur. For central and posterolateral disc herniations, the injection is performed one level below the disc in question. Epidurally injected corticosteroids can blunt the endogenous cortisol response for up to 3 months. Although this is rarely clinically apparent, it is one of the reasons that courses of injections are usually limited to three. Epidural steroids do not have the degree of adverse effects associated with continuous oral steroids. Although there can be a slight degree of hyperglycemia associated with steroid injections, it is not a contraindication to the use of epidural steroids in diabetics. Burn et al. demonstrated that flow occurs most frequently in the cephalad direction. Dye studies have shown that, while the volume of injection is directly related to the spread of solutions, very little can be predicted about the location of spread. Generally, volumes required for the transforaminal approach vary least. This picture is typical of a vasodepressor response that can be seen in reaction to deep somatic pain. It is unlikely that even with a dural puncture the solution would spread to the cervical region. Facial flushing can result from corticosteroid injection, but it is unlikely that hypotension and bradycardia would occur.
Arch Phys Med Rehabil Vol 81, March 2000
2000 SAE-P: Lumbosacral Epidural Steroid Injections Answer Key And Commentary on Preferred Choice QUESTION
ANSWER
COMMENTARY
1.
(d)
2.
(c)
3.
(a)
4.
(a)
5.
(d)
The presence of nerve root compression is not sufficient to cause radicular pain, as relief of pressure does not always result in pain relief, while the persistence of pressure does not always result in continued pain. There is evidence that an inflammatory response involving phospholipase A (and possibly also prostaglandins and leukotrienes) is responsible for mediating the radicular pain response. Foraminal injections at the level of the disc pathology on the symptomatic side is recommended for lateral or foraminal disc herniations. Caudal injections are only optimal for pathology at the L5-S 1 disc because sufficient cephalad spread may not occur. For central and posterolateral disc herniations, the injection is performed one level below the disc in question. Epidurally injected corticosteroids can blunt the endogenous cortisol response for up to 3 months. Although this is rarely clinically apparent, it is one of the reasons that courses of injections are usually limited to three. Epidural steroids do not have the degree of adverse effects associated with continuous oral steroids. Although there can be a slight degree of hyperglycemia associated with steroid injections, it is not a contraindication to the use of epidural steroids in diabetics. Burn et al. demonstrated that flow occurs most frequently in the cephalad direction. Dye studies have shown that, while the volume of injection is directly related to the spread of solutions, very little can be predicted about the location of spread. Generally, volumes required for the transforaminal approach vary least. This picture is typical of a vasodepressor response that can be seen in reaction to deep somatic pain. It is unlikely that even with a dural puncture the solution would spread to the cervical region. Facial flushing can result from corticosteroid injection, but it is unlikely that hypotension and bradycardia would occur.
Arch Phys Med Rehabil Vol 81, March 2000