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Spine Intervention Society
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2019-02-07 23:00:13.909156
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1 SPINE INTERVENTION SOCIETYSIS JUNE 1, 2017DOWNLOADED FROM SPINEINTERVENTION.ORG/FACTFINDERS ©2017 SPINE INTERVENTION SOCIETY. ALL RIGHTS RESERVED . Systemic Effects of Epidural Corticosteroid Injection Wade King, MMed; David C. Miller, MD, MA; and Clark Smith, MD, MPH on behalf of the Spine Intervention Society™s Patient Safety Committee Myth: Transforaminal and interlaminar epidural injections of corticosteroids can be administered without concern for systemic effects because the doses used are small and intermittent. Fact: The doses of corticosteroids administered in interventional spine procedures have systemic effects, especially when the patient has a steroid-dependent condition such as diabetes mellitus or has multiple exposures to steroids. Transforaminal and interlaminar epidural injections of corticosteroids are used to treat radicular pain. The epidural plexus of veins, and can exert systemic effects. The risk of side-effects is dependent on the dose used and the number of injections given over time. The nature of systemic effects depends on the systems affected and the duration of exposure to steroids. PharmacologyThe corticosteroids used in spinal pain management are glucocorticoids. They act by binding to glucocorticoid Glucocorticoids are metabolized in the liver to inactive glucuronides and sulfates, and are excreted mainly by the kidneys, but also in feces. The half-lives of glucocorticoids vary, but are of the order of several days. For example, the side-effects. DoseFor transforaminal injection of steroids (TFIS) dexamethasone has become the preferred agent, because it does not such as triamcinolone or betamethasone have been used in the past. For interlaminar epidural injections similar one nerve root is the target. There are no published data comparing the incidence, severity or duration of systemic Systemic Side-Effects Long-term systemic side-effects may arise if corticosteroids are administered on a continuing basis, or given repeatedly at intervals too short for the body to have cleared the previous dose(s). Long-term effects may be caused directly by excess glucocorticoid in the circulation or indirectly through suppression of the hypothalamic-pituitary
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