The safety of CT-guided epidural steroid injections in an older patient cohort

Andrew J. Fenster, Kevin Fernandes, Allan L. Brook, Todd S. Miller

Research output: Contribution to journalReview article

4 Citations (Scopus)

Abstract

Background: Epidural steroid injections (ESIs) are a common method for treating lower back pain, which is one of the most prevalent health-related complaints in the adult U.S. population. Although the safety of CT-guided ESIs has been extensively studied in adults, there is limited data concerning the procedure’s safety profile in an older patient population. Objective: This retrospective study analyzed safety data among a single-center cohort of patients > 65 years-old who received one or more CT-guided interlaminar ESIs from 2012 to 2015. Study Design: An Institutional Review Board (IRB)-approved retrospective chart review. Setting: University hospital center. Methods: A total of 688 CT-guided ESI procedures were evaluated and a linear regression analysis was conducted to examine the relationship between dose length product (DLP), body mass index (BMI), procedure duration, and kVp/mA settings. Further analysis was performed on a sample of long procedure time, average-DLP and high-DLP procedures. Results: Average age was 75.77 years, with 44% having a BMI > 30. The mean DLP was 55.58 mGy x cm and the mean procedure duration was 5.94 minutes. All procedures were technically successful and no complications were observed during or after any of the procedures, including at one-month follow-up office visits. The kVp and mA settings were the strongest predictors of DLP, followed by procedure time. The high-DLP cases had a greater number of needle placement series, more intervertebral disc spaces included in each planning series and higher machine settings (kVp 120; mA 87.5) than the average-DLP cases (kVp 100; mA 49.9). Limitations: This study is limited by its retrospective design. Conclusion: CT-guided interlaminar ESIs can be performed safely, with low procedure times, relatively low DLP’s and without complications in an older patient population.

Original languageEnglish (US)
Pages (from-to)E1139-E1146
JournalPain Physician
Volume19
Issue number8
StatePublished - Nov 1 2016

Fingerprint

Epidural Injections
Steroids
Safety
Body Mass Index
Population
Office Visits
Intervertebral Disc
Research Ethics Committees
Low Back Pain
Needles
Linear Models

Keywords

  • Back pain
  • Cervical spine
  • CT-guidance
  • Dose length product
  • Epidural steroid injection
  • Interlaminar approach
  • Lumbar spine
  • Older adults
  • Radiation exposure
  • Thoracic spine

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Fenster, A. J., Fernandes, K., Brook, A. L., & Miller, T. S. (2016). The safety of CT-guided epidural steroid injections in an older patient cohort. Pain Physician, 19(8), E1139-E1146.

The safety of CT-guided epidural steroid injections in an older patient cohort. / Fenster, Andrew J.; Fernandes, Kevin; Brook, Allan L.; Miller, Todd S.

In: Pain Physician, Vol. 19, No. 8, 01.11.2016, p. E1139-E1146.

Research output: Contribution to journalReview article

Fenster, AJ, Fernandes, K, Brook, AL & Miller, TS 2016, 'The safety of CT-guided epidural steroid injections in an older patient cohort', Pain Physician, vol. 19, no. 8, pp. E1139-E1146.
Fenster AJ, Fernandes K, Brook AL, Miller TS. The safety of CT-guided epidural steroid injections in an older patient cohort. Pain Physician. 2016 Nov 1;19(8):E1139-E1146.
Fenster, Andrew J. ; Fernandes, Kevin ; Brook, Allan L. ; Miller, Todd S. / The safety of CT-guided epidural steroid injections in an older patient cohort. In: Pain Physician. 2016 ; Vol. 19, No. 8. pp. E1139-E1146.
@article{82f9142ddfc246a99ac4e9de4c605b17,
title = "The safety of CT-guided epidural steroid injections in an older patient cohort",
abstract = "Background: Epidural steroid injections (ESIs) are a common method for treating lower back pain, which is one of the most prevalent health-related complaints in the adult U.S. population. Although the safety of CT-guided ESIs has been extensively studied in adults, there is limited data concerning the procedure’s safety profile in an older patient population. Objective: This retrospective study analyzed safety data among a single-center cohort of patients > 65 years-old who received one or more CT-guided interlaminar ESIs from 2012 to 2015. Study Design: An Institutional Review Board (IRB)-approved retrospective chart review. Setting: University hospital center. Methods: A total of 688 CT-guided ESI procedures were evaluated and a linear regression analysis was conducted to examine the relationship between dose length product (DLP), body mass index (BMI), procedure duration, and kVp/mA settings. Further analysis was performed on a sample of long procedure time, average-DLP and high-DLP procedures. Results: Average age was 75.77 years, with 44{\%} having a BMI > 30. The mean DLP was 55.58 mGy x cm and the mean procedure duration was 5.94 minutes. All procedures were technically successful and no complications were observed during or after any of the procedures, including at one-month follow-up office visits. The kVp and mA settings were the strongest predictors of DLP, followed by procedure time. The high-DLP cases had a greater number of needle placement series, more intervertebral disc spaces included in each planning series and higher machine settings (kVp 120; mA 87.5) than the average-DLP cases (kVp 100; mA 49.9). Limitations: This study is limited by its retrospective design. Conclusion: CT-guided interlaminar ESIs can be performed safely, with low procedure times, relatively low DLP’s and without complications in an older patient population.",
keywords = "Back pain, Cervical spine, CT-guidance, Dose length product, Epidural steroid injection, Interlaminar approach, Lumbar spine, Older adults, Radiation exposure, Thoracic spine",
author = "Fenster, {Andrew J.} and Kevin Fernandes and Brook, {Allan L.} and Miller, {Todd S.}",
year = "2016",
month = "11",
day = "1",
language = "English (US)",
volume = "19",
pages = "E1139--E1146",
journal = "Pain Physician",
issn = "1533-3159",
publisher = "Association of Pain Management Anesthesiologists",
number = "8",

}

TY - JOUR

T1 - The safety of CT-guided epidural steroid injections in an older patient cohort

AU - Fenster, Andrew J.

AU - Fernandes, Kevin

AU - Brook, Allan L.

AU - Miller, Todd S.

PY - 2016/11/1

Y1 - 2016/11/1

N2 - Background: Epidural steroid injections (ESIs) are a common method for treating lower back pain, which is one of the most prevalent health-related complaints in the adult U.S. population. Although the safety of CT-guided ESIs has been extensively studied in adults, there is limited data concerning the procedure’s safety profile in an older patient population. Objective: This retrospective study analyzed safety data among a single-center cohort of patients > 65 years-old who received one or more CT-guided interlaminar ESIs from 2012 to 2015. Study Design: An Institutional Review Board (IRB)-approved retrospective chart review. Setting: University hospital center. Methods: A total of 688 CT-guided ESI procedures were evaluated and a linear regression analysis was conducted to examine the relationship between dose length product (DLP), body mass index (BMI), procedure duration, and kVp/mA settings. Further analysis was performed on a sample of long procedure time, average-DLP and high-DLP procedures. Results: Average age was 75.77 years, with 44% having a BMI > 30. The mean DLP was 55.58 mGy x cm and the mean procedure duration was 5.94 minutes. All procedures were technically successful and no complications were observed during or after any of the procedures, including at one-month follow-up office visits. The kVp and mA settings were the strongest predictors of DLP, followed by procedure time. The high-DLP cases had a greater number of needle placement series, more intervertebral disc spaces included in each planning series and higher machine settings (kVp 120; mA 87.5) than the average-DLP cases (kVp 100; mA 49.9). Limitations: This study is limited by its retrospective design. Conclusion: CT-guided interlaminar ESIs can be performed safely, with low procedure times, relatively low DLP’s and without complications in an older patient population.

AB - Background: Epidural steroid injections (ESIs) are a common method for treating lower back pain, which is one of the most prevalent health-related complaints in the adult U.S. population. Although the safety of CT-guided ESIs has been extensively studied in adults, there is limited data concerning the procedure’s safety profile in an older patient population. Objective: This retrospective study analyzed safety data among a single-center cohort of patients > 65 years-old who received one or more CT-guided interlaminar ESIs from 2012 to 2015. Study Design: An Institutional Review Board (IRB)-approved retrospective chart review. Setting: University hospital center. Methods: A total of 688 CT-guided ESI procedures were evaluated and a linear regression analysis was conducted to examine the relationship between dose length product (DLP), body mass index (BMI), procedure duration, and kVp/mA settings. Further analysis was performed on a sample of long procedure time, average-DLP and high-DLP procedures. Results: Average age was 75.77 years, with 44% having a BMI > 30. The mean DLP was 55.58 mGy x cm and the mean procedure duration was 5.94 minutes. All procedures were technically successful and no complications were observed during or after any of the procedures, including at one-month follow-up office visits. The kVp and mA settings were the strongest predictors of DLP, followed by procedure time. The high-DLP cases had a greater number of needle placement series, more intervertebral disc spaces included in each planning series and higher machine settings (kVp 120; mA 87.5) than the average-DLP cases (kVp 100; mA 49.9). Limitations: This study is limited by its retrospective design. Conclusion: CT-guided interlaminar ESIs can be performed safely, with low procedure times, relatively low DLP’s and without complications in an older patient population.

KW - Back pain

KW - Cervical spine

KW - CT-guidance

KW - Dose length product

KW - Epidural steroid injection

KW - Interlaminar approach

KW - Lumbar spine

KW - Older adults

KW - Radiation exposure

KW - Thoracic spine

UR - http://www.scopus.com/inward/record.url?scp=85001130032&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85001130032&partnerID=8YFLogxK

M3 - Review article

C2 - 27906944

AN - SCOPUS:85001130032

VL - 19

SP - E1139-E1146

JO - Pain Physician

JF - Pain Physician

SN - 1533-3159

IS - 8

ER -