Document Detail


Intra-arterial injection in the rat brain: evaluation of steroids used for transforaminal epidurals.
MedLine Citation:
PMID:  19770605     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY DESIGN: Prospective in vivo experimental animal model. OBJECTIVES: To determine the effect of intra-arterial injection of the steroids commonly used for transforaminal epidurals on the central nervous system. And to determine if all of the steroids have the same effect. SUMMARY OF BACKGROUND DATA.: Transforaminal epidural steroid injection is commonly employed to treat radicular pain. This approach is associated with complications, including stroke and death. While the mechanism is unknown, the leading hypothesis is that intravascular injection of particulate steroids leads to microembolization. METHODS: To characterize the nature of steroid induced injury, a rodent model was employed. The internal carotid artery was dissected and its branches ligated. The external carotid artery was ligated, mobilized, cannulated, and injectate administered. Five solutions were tested: Depo-Medrol (N = 11), Depo-Medrol carrier (N = 6), Solu-Medrol (N = 6), Decadron (N = 8), and normal saline (N = 7). Drugs, in volume of 50 microL, were injected into the ICA via the ECA cannula at 25 microL/min. The extent of central nervous system injury was evaluated by analysis of coronal sections of the brain. RESULTS: Cerebral hemorrhage occurred in test subjects with the following frequency: 8 of 11 in the Depo-Medrol group, 7 of 8 in the Solu-Medrol group, and 3 of 6 in the Depo-Medrol carrier group; no lesions were identified in the Decadron or saline groups (P < 0.01). Evan's blue dye leakage was detected in the Depo-Medrol and Solu-Medrol groups, but not the Decadron or saline groups. CONCLUSION: This study presents the first in vivo evaluation of intra-arterial steroid injection. Data demonstrate Depo-Medrol, as well as its nonparticulate carrier, and Solu-Medrol can produce significant injury to the blood-brain barrier when injected intra-arterially. These results demonstrate that injury is produced not only by particulate obstruction of the cerebral microvasculature, but also by toxicity of the carrier or steroid (methylprednisolone).
Authors:
Joshua D Dawley; Tobias Moeller-Bertram; Mark S Wallace; Piyush M Patel
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Spine     Volume:  34     ISSN:  1528-1159     ISO Abbreviation:  Spine     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-09-22     Completed Date:  2010-01-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1638-43     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology, UCSD, San Diego, CA, USA.
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MeSH Terms
Descriptor/Qualifier:
Analgesia, Epidural / adverse effects,  methods
Animals
Blood-Brain Barrier / drug effects,  pathology
Brain / drug effects*,  pathology
Carotid Artery, External
Central Nervous System Diseases / etiology
Dexamethasone / administration & dosage,  analogs & derivatives,  toxicity
Drug Carriers / administration & dosage,  toxicity
Injections, Epidural
Injections, Intra-Arterial
Methylprednisolone / administration & dosage,  analogs & derivatives,  toxicity
Methylprednisolone Hemisuccinate / administration & dosage,  toxicity
Models, Animal
Rats
Rats, Wistar
Sodium Chloride / administration & dosage,  toxicity
Steroids / administration & dosage*,  toxicity
Chemical
Reg. No./Substance:
0/Drug Carriers; 0/Steroids; 2921-57-5/Methylprednisolone Hemisuccinate; 312-93-6/dexamethasone 21-phosphate; 50-02-2/Dexamethasone; 53-36-1/methylprednisolone acetate; 7647-14-5/Sodium Chloride; 83-43-2/Methylprednisolone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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