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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. Key words: Epidural steroid injection, interlaminar approach, CT-guidance, older adults, back pain, lumbar spine, thoracic spine, cervical spine, dose length product, radiation exposure

Image guidance for spine pain control procedures, including epidural steroid injection, nerve root block, and facet block, can be performed with either computed tomography (CT) or conventional fluoroscopy. CT has the advantage of improved anatomic localization and use of air for contrast; however, there are concerns that CT leads to higher radiation dose and longer procedure time.To evaluate procedure time and radiation dose for multiple types of spine pain control procedures performed under CT guidance.Retrospective evaluation.Department of radiology in single academic medical center.Institutional review board approval was obtained. We reviewed CT-guided spine procedures performed over a 12-month period from January 2012 to December 2012. Procedure type, procedure time, and dose-length product were recorded. Patient age and gender were recorded for each case; additionally, demographic and medical history data were obtained for a sub-group of patients.Nine hundred ninety-four studies (performed in 699 patients) were reviewed, including 585 epidural steroid injections, 228 nerve root blocks, and 90 facet blocks. For all studies, procedure time averaged 7:34 ± 5:05, and dose-length product averaged 75 mGy·cm ± 61. Additional medical history (available for 483 patients) revealed high rate of obesity (body mass index [BMI] = 30 ± 6.8, with 76% of patients overweight [BMI25] and 42% obese [BMI30]), and frequent medical comorbidities (including hypertension [n = 179], diabetes [n = 101], renal failure [n = 30], and heart failure [n = 17]).This study was performed retrospectively, and limited to a single institution.These findings add to the growing evidence that CT guidance is a safe and effective technique for epidural steroid injection. These results further demonstrate that other spine intervention procedures, including nerve root block and facet block, can also be performed under CT guidance with short procedure time and reasonable levels of radiation exposure. This approach can be effectively used in a patient population with a high rate of obesity and medical comorbidities.

Background: Hospital admissions for back pain are prolonged, costly, and common. Epidural steroid injections are frequently performed in an outpatient setting with an excellent safety and efficacy profile. Objectives: The purpose was to review data from patients with severe pain that did not respond to aggressive medical treatment in the emergency department (ED) and determine the effectiveness of an interlaminar epidural steroid injection (ESI) in this patient population. Study Design: Retrospective matched cohort design. Setting: Single urban emergency department at a tertiary referral center. Methods: A retrospective cohort comparison pairing 2 groups that both failed aggressive pain control in the ED was performed. The epidural injection group (1ESI) received an interlaminar ESI while in the ED. The standard therapy group (2ST) was admitted for medical pain management. Groups were matched for pain intensity, age, and symptom duration. Results: Thirty-five patients in 1ESI (NRS 8.8, 5 – 10, 0.35), and 28 patients in 2ST (NRS 8.9, 4 – 10, 1.7). Pain score after ESI 0.33 (0 – 2, 0.6); all were discharged. Pain score on day 1 of hospital admission for 2ST was 8.7 (7 – 10, 1.5). Total ED time was 8 hours for 1ESI and 13 hours for 2ST (P < 0.002). 1ESI patients received less narcotics while in the ED (P < 0.002) and were discharged home with less narcotics than 2ST (< 0.002). Average inpatient length of stay (LOS) for 2ST was 5 (1.5 – 15, 3.3) days. Cost of care was over 6 times greater for those patients admitted for pain management (P < 0.001). Limitations: Retrospective design, non-randomized sample, and a small patient population. Conclusion: An ED patient cohort with severe refractory pain was treated with an interlaminar ESI after failing maximal medical pain management while in the ED. Complete pain relief was achieved safely and rapidly. The need for inpatient admission was eliminated after injection. Costs were lower in the group that received an epidural injection. Narcotic requirements upon discharge were decreased as well. Key words: Low back pain, epidural steroid injection, emergency department, hospital admission