Cervical steroid injections and weight gain

The caudal approach to the epidural space involves the use of a Tuohy needle, an intravenous catheter, or a hypodermic needle to puncture the sacrococcygeal membrane . Injecting local anaesthetic at this level can result in analgesia and/or anaesthesia of the perineum and groin areas. The caudal epidural technique is often used in infants and children undergoing surgery involving the groin, pelvis or lower extremities. In this population, caudal epidural analgesia is usually combined with general anaesthesia since most children do not tolerate surgery when regional anaesthesia is employed as the sole modality.

Manipulation can also be helpful. This requires care in selection of technique, however, carefully implemented adjustments can help remove pressure on the nerve root and assist in healing, especially in the latter stages where residual affects from healing like scar tissue can limit motion and cause onging pain. Initially, chiropractic techniques like flexion/distraction manipulation provides careful and controlled manually applied traction using special tables. This is usually employed in conjunction with therapeutic agents described previously.

The patient's clinical picture is consistent with cervical spondylosis. Minimal symptoms without hard evidence of gait disturbance or pathologic reflexes warrant nonoperative treatment, making physical therapy the correct answer.

Cervical spondylosis is a process that results in disc degeneration and facet arthropathy. Clinical manifestations may range from axial neck pain to profound muscle weakness and difficulties ambulating. It is generally agreed upon that patients with neuroradiologic evidence of spinal cord compression but no signs of myelopathy should be managed non-operatively. Initial management should consist of physical therapy, NSAIDs, and a cervical collar for comfort.

Boden and McCowin et al. describe the prevalence of abnormal cervical spine MRI findings in asymptomatic patients. 19 percent of asymptomatic patients were found to have abnormal scans. The most common finding in subjects less than 40 years old was a herniated disc, while the most common finding in subjects greater than 40 years of age was foraminal stenosis.

Kadanka and Mares et al. provide a prospective, randomized study comparing conservative and operative treatment of mild and moderate forms of spondylotic cervical myelopathy. At the 3-year follow-up period, there were no significant differences between the surgical and conservative treatment groups.

Figure A shows a lateral radiograph with loss of cervical lordosis and mild degenerative changes at C5-6, C6-7. Figures B shows a sagittal MRI with mild stenosis and loss of cervical lordosis. Figure C shows the axial MRI with left-sided foraminal stenosis at C5-6.

Incorrect Answers:
Answers 1-4: non-operative management is recommended in this situation.

As a skilled and experienced Pain Medicine Interventionalist, Dr. Levin evaluates each patient very thoroughly and carefully to help determine appropriate treatment options in order to provide the most effective individualized care.  These treatment options may include:  Lumbar, Thoracic and Cervical Epidural Steroid Injections utilizing targeted transforaminal techniques, Lumbar and Cervical Sympathetic Blocks, Sphenopalatine, Facial and Head and Neck Procedures, Discography, Percutaneuos Discectomy or Disc Decompression procedures, precision joint and nerve injections, Radiofrequency Neuroablative procedures, Peripheral or Spinal Cord Stimulator trials and implants, Foraminoplasties and several patented and patent pending advanced interventional procedures.

Cervical steroid injections and weight gain

cervical steroid injections and weight gain

As a skilled and experienced Pain Medicine Interventionalist, Dr. Levin evaluates each patient very thoroughly and carefully to help determine appropriate treatment options in order to provide the most effective individualized care.  These treatment options may include:  Lumbar, Thoracic and Cervical Epidural Steroid Injections utilizing targeted transforaminal techniques, Lumbar and Cervical Sympathetic Blocks, Sphenopalatine, Facial and Head and Neck Procedures, Discography, Percutaneuos Discectomy or Disc Decompression procedures, precision joint and nerve injections, Radiofrequency Neuroablative procedures, Peripheral or Spinal Cord Stimulator trials and implants, Foraminoplasties and several patented and patent pending advanced interventional procedures.

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