• Users Online: 1023
  • Print this page
  • Email this page
CASE REPORT
Year : 2020  |  Volume : 6  |  Issue : 3  |  Page : 41-44

Epidural steroid and facet joint injection neck in elderly patient: A combined approach


Department of Anaesthesia and Intensive Care, Acharya Shri Chander College of Medical Sciences, Sidhra, Jammu, India

Correspondence Address:
Nandita Mehta
Department of Anaesthesia and Intensive Care, Acharya Shri Chander College of Medical Sciences, Jammu, Jammu and Kashmir
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jrap.jrap_7_21

Rights and Permissions

Cervical radicular pain is often due to a combination of factors including intervertebral disc prolapse or herniation, narrowing of the intervertebral foramen, osteoarthritis of facet joints, and spondylolisthesis. Cervical Epidural with local anesthetics along with steroids is used for evaluation and management of radicular pain in patients with pathology that exists at multiple vertebral levels. Medial branch block is given for facet joint arthropathy both for diagnostic and therapeutic purposes. Therefore, the aim of performing this procedure was to provide an interlaminar epidural steroid injection at C7-T1 vertebral level along with a diagnostic right medial branch block under fluoroscopic guidance to 86 years old hypertensive female, with complaints of pain in the neck lower portion, upper part of back and shoulder on the right side, radiating down the arm up to medial two fingers and thumb for 2 years. An interlaminar epidural steroid injection was planned on the right side at the C7-T1 vertebral level under C-arm guidance. A diagnostic right medial branch block was also planned to be given on the same day at 2 levels C5/C6 and C6/C7 facet joint each using 2 mg dexamethasone (0.5 ml) and 1.5 ml of 1% lignocaine. A repeat epidural injection was given using a combination of 1 ml of steroid dexamethasone (4 mg) and 3 ml of 1% lignocaine along with facet medial branch block injection at the same levels using 0.5% bupivacaine 1.5 ml and 2 mg dexamethasone (0.5 ml) on her follow-up visit after 6 weeks. Following the block patient on her first visit, she had considerable pain relief with a visual analog scale (VAS) of 3. She was prescribed gabapentin, methyl-cobalamine and clonazepam. After 6 weeks, the patient had VAS score of 6. She looked comfortable and her paresthesia had grossly improved. At the end of the procedure, patient had good pain relief with no deficit. She was advised to continue gabapentin. On her third follow-up after 3 months, the patient presented with >70% relief in her initial pain with a VAS of <3 and minimal paresthesia along the distribution of the ulnar nerve and hence required no intervention. Cervical epidural steroid injections under fluoroscopy guidance are being used for the conservative management of neck pain or cervical radiculopathy. Facet joint injections and medial branch blocks aim to diagnose and treat the pain arising from facet joints in the spine. It is also important to prescribe drugs to manage the neuropathic component of the pain.


[FULL TEXT] [PDF]*
Print this article     Email this article
 Next article
 Previous article
 Table of Contents

 Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
 Citation Manager
 Access Statistics
 Reader Comments
 Email Alert *
 Add to My List *
 * Requires registration (Free)
 

 Article Access Statistics
    Viewed175    
    Printed10    
    Emailed0    
    PDF Downloaded15    
    Comments [Add]    

Recommend this journal