Department of Physical Medicine and Rehabilitation, UT Health San Antonio, San Antonio, TX.
Division of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT.
PM R. 2020 Jan;12(1):49-54. doi: 10.1002/pmrj.12192. Epub 2019 Sep 11.
Epidural steroid injections (ESI) are commonly used to treat refractory radicular spinal pain. Although evidence suggests that an increasing cumulative dose of exogenous corticosteroid may be harmful, knowledge of current practice patterns is limited regarding the choice of dose and frequency of epidural steroid injections (ESIs).
Describe current practice trends in the dose selection and frequency of administration of transforaminal ESIs (TFESIs) and interlaminar ESIs (ILESIs).
Cross-sectional survey study.
Not applicable.
Three hundred fourteen physician members of the Spine Intervention Society (SIS). From May to June 2018, an online survey was distributed to 5907 physician members of the SIS.
Not applicable.
Corticosteroid dose used by practitioners and the number of annual ESIs administered per patient.
Three hundred fourteen physicians responded to the survey. For single cervical or lumbar injections of dexamethasone, most physicians (56.0%) reported using 10 mg; 17% of physicians reported use of doses greater than 10 mg, with 6% using a dose of 20 mg per injection level. The most common particulate corticosteroid dose used during both cervical and lumbar ILESIs was 80 mg (cervical = 55.4%, lumbar = 54.7%). During cervical and lumbar ILESIs, 17% and 12.7% of physicians reported using doses greater than 80 mg, respectively. Almost 10% of physicians reported performing cervical TFESIs with particulate steroids. Forty percent of physicians reported allowing four ESIs at a given spinal segmental level per year (cervical/thoracic/lumbosacral). A small percentage of physicians reported allowing more than six ESIs annually (6%) and >10 injections annually (1%).
There is considerable variability among this large cohort of interventionists with regard to corticosteroid dose selection and epidural steroid injection frequency. A small proportion of respondents reported Mulitsociety Pain Workgroup guideline-discordant use of particulate steroids during cervical TFESIs. These findings demonstrate a need for additional research regarding both the reasons for such variation in care and the reasons for guideline-discordant practice in a subset of physicians.
IV.
硬膜外类固醇注射（ESI）常用于治疗难治性神经根性脊柱疼痛。尽管有证据表明，外源性皮质类固醇的累积剂量增加可能有害，但对于硬膜外类固醇注射（ESI）的剂量选择和频率的当前实践模式知之甚少。
描述经椎间孔硬膜外注射（TFESI）和经椎间孔硬膜外注射（ILESI）中剂量选择和给药频率的当前实践趋势。
横断面调查研究。
不适用。
脊柱介入学会（SIS）的 314 名医师成员。2018 年 5 月至 6 月，向 SIS 的 5907 名医师成员在线分发了一项调查。
不适用。
从业者使用的皮质类固醇剂量和每位患者每年进行的 ESI 次数。
314 名医师对调查做出了回应。对于单次颈椎或腰椎注射地塞米松，大多数医师（56.0%）报告使用 10mg；17%的医生报告使用剂量大于 10mg，其中 6%在每个注射水平使用 20mg 的剂量。在颈椎和腰椎 ILESI 中最常用的颗粒状皮质类固醇剂量均为 80mg（颈椎=55.4%，腰椎=54.7%）。在颈椎和腰椎 ILESI 中，分别有 17%和 12.7%的医生报告使用剂量大于 80mg。近 10%的医生报告进行了带有颗粒状类固醇的颈椎 TFESI。40%的医生报告允许在给定的脊柱节段水平每年进行 4 次 ESI（颈椎/胸椎/腰骶）。一小部分医生报告允许每年进行超过 6 次 ESI（6%）和每年超过 10 次注射（1%）。
在大量介入治疗师中，皮质类固醇剂量选择和硬膜外类固醇注射频率存在相当大的差异。一小部分受访者报告在颈椎 TFESI 中使用颗粒状类固醇时与多学会疼痛工作组指南不一致。这些发现表明，需要进一步研究护理差异的原因以及一部分医生与指南不一致的实践原因。
IV。
