Johnson B A
Department of Radiology, University of Minnesota Medical School, Minneapolis, USA.
Neuroimaging Clin N Am. 2000 Aug;10(3):479-91.
Epidural steroid injection is a safe outpatient procedure, which is performed best using image guidance in conjunction with epidurography. Using the techniques described earlier, complications are minimized, and serious complications can be avoided, in experienced hands. The author has performed several thousand procedures in an outpatient setting without any serious complications. Optimal safety and efficacy require an excellent working knowledge of the radiographic anatomy, and the imaging equipment used to perform these procedures. Several studies have demonstrated the difficulty and uncertainty of obtaining an accurate injection without imaging guidance. Radiologists who are well trained in the performance of image-guided percutaneous injection procedures are thus armed with the background to perform these procedures in a safe and efficacious manner. In addition, referral of these procedures to a third party (radiologist) without economic incentives reduces the potential abuse of self-referral--which may occur (or be suspected by payors) when the primary clinician recommends, and then performs, pain management procedures. The use of sedation to perform these procedures is unnecessary, and deep sedation may be dangerous when injections are performed in the vicinity of the spinal cord. The author's experience, which includes clinical feedback and formal trials, shows the technique described in this article to be performed safely without sedation in an outpatient setting, with a high success rate for alleviating pain symptoms. When properly performed, epidural steroid injections have a clinically established role in the management of neck and back pain.
硬膜外类固醇注射是一种安全的门诊手术，最好在影像引导下结合硬膜外造影进行。采用上述技术，在经验丰富的医生操作下，并发症可降至最低，严重并发症可避免。作者在门诊环境中已进行了数千例手术，未出现任何严重并发症。最佳的安全性和有效性需要对放射解剖学以及用于实施这些手术的成像设备有深入的了解。多项研究表明，在没有影像引导的情况下进行准确注射存在困难和不确定性。因此，接受过影像引导下经皮注射手术培训的放射科医生具备以安全有效的方式实施这些手术的背景知识。此外，将这些手术转交给第三方（放射科医生）且无经济激励措施，可减少自我转诊的潜在滥用情况——当初级临床医生推荐并随后实施疼痛管理手术时，这种滥用情况可能会发生（或被付款方怀疑）。实施这些手术时无需使用镇静剂，在脊髓附近进行注射时深度镇静可能很危险。作者的经验，包括临床反馈和正式试验，表明本文所述技术在门诊环境中无需镇静即可安全实施，缓解疼痛症状的成功率很高。正确实施时，硬膜外类固醇注射在颈部和背部疼痛的管理中具有已确立的临床作用。
