Inyección Epidural de Esteroides a Nivel Cervical: Una Revisión Narrativa
DOI:
https://doi.org/10.47924/neurotarget202110Palabras clave:
dolor radicular cervical, inyecciones epidurales de esteroides cervicales, vía transforaminalResumen
El dolor de cuello es la cuarta causa de discapacidad en Estados Unidos. El riesgo durante la vida de desarrollar cervicalgia es casi del 50% en la población general. El dolor radicular cervical tiene una incidencia anual estimada de 1 a 3,5 cada 1000 personas, con un pico entre los 40 y 50 años.
El tratamiento multidisciplinario, con una combinación de un esquema farmacológico, fisioterapia, soporte psicológico o psiquiátrico y la inyección epidural de esteroides cervical ha mostrado los mejores resultados.
Las inyecciones epidurales cervicales de esteroides pueden realizarse de modo similar que en el resto de la columna por abordaje interlaminar o transforaminal. Sin embargo, la realización de inyecciones epidurales transforaminales cervicales no son las recomendadas por los autores debido a las raras, pero devastadoras complicaciones observadas con este acceso. El abordaje interlaminar es la opción que cuenta con mayor soporte de la evidencia y por tanto es la recomendada en los algoritmos propuestos para este fin.
En el presente trabajo, se realiza una revisión narrativa de los aspectos farmacológicos, los accesos utilizados en las inyecciones epidurales cervicales de esteroides y su perfil de complicaciones, así como la monitorización necesaria para brindar seguridad a nuestros pacientes.
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Cohen S. Epidemiology, diagnosis, and treatment of neck pain. Mayo Clin Proc 2015;90(2):284–99.
Fejer R, Kyvik K, Hartvigsen J. The prevalence of neck pain in the world population: a systematic critical review of the literature. Eur Spine J 2006;15(6):834–48.
Iyer S, Kim H. Cervical radiculopathy. Curr Rev Musculoskelet Med 2016;9: 272–80.
Manchikanti L, Singh V. Interventional techniques in Chronic Spinal Pain, 2007 ASIPP Publishing (first edition)
Van Zundert J, Huntoon M, Patijn J. Cervical radicular pain. 2009 World Institute of Pain, Pain Practice, Volume 10, Issue 1, 2010 1–17
Cohen SP, Hayek S, Semenov Y et al. Epidural steroid injections treatment, or combination treatment for cervical radicular pain. A multi-center, randomized, comparative-effectiveness study. Anesthesiology 2014;121:1045-1055
Manchikanti L, Abdi S, Alturi S et al. An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and recommendations. Pain Physician 2013, April 16:S49-S283
Benyamin RM, Singh V, Parr AT, Conn A, DiwanS, Abdi S. Systematic review of the effectiveness of cervical epidurals in the mana-gement of chronic neck pain. Pain Physician 2009; 12: 137-157.
Wang E, Wang D. Treatment of Cervicogenic Headache with Cervical Epidural Steroid Injection. Curr Pain Headache Rep 2014, 18:442
House LM, Barrette K, Mattie R, McCormick ZL. Cervical epidural steroid injection. Techniques and Evidence. Phys Med Rehabil Clin N Am. 2018 Feb;29(1):1-17.
Slipman CW, Lipetz JS, Jakson HB, Rogers DP, Vresilovic EJ. Therapeutic selective nerve root block in the nonsurgical treatment of atraumatic cervical spondylotic radicular pain: a retrospective analysis with independent clinical review. Arch Phys Med Rehabil 2000; 81: 741-746
Rathmell J, Aprill C, Bogduk N. Cervical transforaminal injection of steroids. Anesthe-siology 2004; 100:1595-1600
Rathmell JP, Benzon HT, Dreyfuss P et al. Safeguards to prevent neurologic complicati-ons after epidural steroid injections. Consensus opinions from a Multidisciplinary Working Group and National Organizations. Anesthe-siology 2015 May; 122(5):974-84
Knevezic NN, Jovanovic F, Voronov D, Candido K. Do corticosteroids still have a place in the treatment of chronic pain? Frontiers in pharmacology 2018; 9:1-9
Kennedy DJ, Plastaras CH, Casey E Visco ChJ et al. Comparative effectiveness of lumbar transforaminal epidural steroid injections with particulate versus nonparticulate corticoste-roids for lumbar radicular pain due to intervertebral disc hernation: a prospective, randomized, double-blind trial. Pain Medicine 2014; 15:548-555
Tiso RL, Cutler T, Catania JA, Whalen K, Pharm BS. Adverse central nervous sequelae after transforaminal block: the role of corticosteroids. The Spine Journal 2004 (4):468-476
Laemell E, Segal N, Mirshahi, Azzazene D, Le marchand S, Wybier M, Vicaut E, Laredo JD. Effects of Intra-arterial Administration of Particulate Steroids on Microvascular Perfusion. Radiology 2016; 279 (6):731-740
Denis I, Claveau G, Filiatrault M, Fugere F, Fortin L. Randomized double-blind controlled trial comparing the effectiveness of lumbar transforaminal epidural injections of particulate and nonparticulate corticosteroids for lumbosacral radicular pain. Pain Medicine 2015 September; 16 (9):1697-708
Park CH, Sang HL, Kim BII. Comparison of the effectiveness of lumbar transforaminal epidural injection with particulate and nonparticulate corticosteroids in lumbar radiating pain. Pain Medicine 2010; 11:1654-1658
EI-Yahchouchi CH, Geske JR, Carter RE et al. The noninferiority of the nonparticulate steroid dexamethasone vs the particulate steroids betamethasone and triamcinolone in lumbar transforaminal epidural steroid injections. Pain Medicine 2013; 14:1650-1657
Kennedy DJ, Plastaras CH, Casey E Visco ChJ et al. Comparative effectiveness of lumbar transforaminal epidural steroid injections with particulate versus nonparticulate corticoste-roids for lumbar radicular pain due to intervertebral disc hernation: a prospective, randomized, double-blind trial. Pain Medicine 2014; 15:548-555
Rabinovitch DL, Peliowski A, Furlan AD. Influence of lumbar epidural injection volume on pain relief for radicular leg pain and/or low back pain. The Spine Journal 2009;9:509-517
Benny B, Azari P, Briones D: Complications of cervical transforaminal epidural steroid injections. Am J Phys Med Rehabil 2010; 89:601–607.
Manchikanti L, Hirsch JA. Neurological complications associated with epidural steroid injections. Curr Pain Headache Rep (2015) 19: 10
Van Zundert J, Patijn, Kessels A, Lamé I, Van Suijlekom H, van Kleef M. Pulsed radiofrequency adjacent to the cervical dorsal root ganglion in chronic cervical radicular pain: A double-blind sham controlled randomized clinical trial. Pain 2007; 127:173-182
Ayala S, Russo M, Castromán P. Radiofrecuencia pulsada del Ganglio de la Raíz Dorsal Cervical: Presentación de un Caso Clínico. Anestesia Analgesia y Reanimación. 2015 vol.28, no.2, p.6-6. ISSN 1688-1273.
Goodman B, Petalcorin JSR, Mallempati S. Optimizing patient positioning and fluorosco-pic imaging for the performance of cervical interlaminar epidural steroid injections. Physical Medicine and Rehabilitation 2010 (2): 783-786
Chin KJ, Karmakar MK Peng Ph. Ultrasonography of the Adult Thoracic and Lumbar Spine for Central Neuraxial Blockade. Anesthesiology 2011; 114:1459 – 85
Vallejo R, Benyamin R, Kramer J. Epidurales cervicales: ¿cómo, ¿dónde y por qué? La controversia continúa. Revista Argentina de Anestesiología 2005 (63)6: 402-406
Moon JY, Lee PB, Nahm FS, Kim Y, Choi JD. Cervical epidural pressure measurement comparison in the prone and sitting positions. Anesthesiology 2010; 113:666 –71
Furman M, Jasper NR, Lin H. Fluoroscopic Contralateral Oblique View in Interlaminar Interventions: A Technical Note. Pain Medicine 2012; 13: 1389–139
Jain G, Helm ER, MD, Nedeljkovic SS, Wasan, AD, Wang H. Multicenter survey of attitudes and perceptions of pain medicine fellows toward the use of lateral versus contralateral-oblique fluoroscopic view for interlaminar cervical epidural injection. Pain Medicine 2015; 16: 692–695
Lee LW Hwang SY, Lee GY, Lee E Kang HS Fluoroscopic cervical paramidline interlaminar epidural steroid injections for cervical radiculopathy: effectiveness and outcome predictors. Skeletal Radiol (2014) 43:933–938
Yoon JY, Kwon JW, MD1, Young YCh, Lee J. Cervical interlaminar epidural steroid injection for unilateral cervical radiculopathy: compari-son of midline and paramedian approaches for efficacy. Korean J Radiol 2015;16(3):604-612
Lirk Ph, Kolbitsch Ch, Putz G, Colvin J, Colvin HP, Lorenz I, Keller Ch, Kirchmair L, Rieder J, Moriggl B. Cervical and High Thoracic Ligamentum Flavum Frequently Fails to Fuse in the Midline. Anesthesiology 2003; 99:1387–90
Sang Pil Yoon1, Hyun Jung Kim2, and Yun Suk Choi2 Anatomic Variations of Cervical and High Thoracic Ligamentum Flavum. Korean J Pain 2014 October; Vol. 27, No. 4: 321-32
Benny B, Azari P, Briones D. Complications of cervical transforaminal epidural steroid injections. Am J Phys Med Rehabil 2010; 89:601–607.
Food and Drug Administration Center for Drug Evaluation and Research: summary minutes of the anesthetic and analgesic drug products advisory committee meeting. http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/AnestheticAndAnalgesicsDrugProductsAdvisoryCommitte/UCM429414.pdf.
Chang Chien GC, Candido KD, Knezevic NN. Digital substraction angiography does not reliably prevent paraplegia associated with lumbar transforaminal epidural steroid injection. Pain Physician 2012;15: 515-523
Horlocker TT. Infectious complications of regional anesthesia. Best Practice and Research Clinical Anesthesiology 2008;22 (3):451-475.
Hooten WM, Kinney MO, Huntoon MA. Epidural abscess and meningitis after epidural corticosteroid injection. Mayo Clin Proc. 2004;79: 682-686
Reynolds F. Neurological infections after neuraxial anesthesia. Anethesiology Clinics 2008; 26:23-52
Manchikanti L, Falco FJE, Benjamin RM, Caraway DL, Helm II S, Wargo BW, Hansen H, Parr AT, Singh V, Hirsch JA. Assessment of infection control practices for interventional techniques: a best evidence synthesis of safe injections practices and use of single-dose medication vials. Pain Physician 2012; 15: E573-E614
Fernandes CR, Fonseca MN, Rosa DM, Simoes CM, Duarte NMC. Recomendaciones de la Sociedad Brasileña de Anestesiología para la seguridad en anestesia regional. Rev Bras Anestesiol 2011;61(5):366-381
Narouze S, Benzon HT, Provenzano DA, Buvanendran A, De Andres J, Deer TR, Rauck R, Huntoon MA. Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications (Second edition). Reg Anesth Pain Med 2018;43: 225-212
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