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Epidural Steroid Injections for Radiculopathy and/or Back Pain in Children and Adolescents: A Retrospective Cohort Study With a Prospective Follow-Up
  1. Katherine E. Kurgansky, MPH*,
  2. Samuel T. Rodriguez, MD*,
  3. Michelle S. Kralj, DPT, MA*,
  4. James J. Mooney, MD*,
  5. Pradeep Dinakar, MD, MS*,
  6. Pierre A. d'Hemecourt, MD,
  7. Daniel J. Hedequist, MD,
  8. Mark R. Proctor, MD and
  9. Charles B. Berde, MD, PhD*
  1. From the Departments of *Anesthesiology, Perioperative and Pain Medicine, †Orthopaedic Surgery, and ‡Neurosurgery, Boston Children's Hospital and Harvard Medical School, Boston, MA
  1. Address correspondence to: Charles B. Berde, MD, PhD, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115 (e-mail: charles.berde{at}


Background and Objectives Epidural steroid injections (ESIs) are commonly performed for adults with spinal pain and/or radiculopathy. Previous pediatric ESI case series were not identified by literature review. The primary aim of this study was to examine the safety and provisional outcomes of pediatric ESIs.

Methods With institutional review board approval, medical records were reviewed for patients aged 9 to 20 years receiving a first ESI at Boston Children's Hospital from 2003 through 2013. A subset of patients completed a Web-based follow-up questionnaire. Descriptive statistics included frequencies, medians, interquartile ranges, and Kaplan-Meier methods. Statistical comparisons were made using Wilcoxon rank sum, χ2, Fisher exact, and Cox proportional hazards regression analyses.

Results A total of 224 patients aged 9 to 20 years underwent 428 ESIs. One hundred seventy-four (76.0%) patients had a lumbar disc herniation with radiculopathy; the others had a spectrum of other spinal disorders. There were no serious adverse events, hospitalizations, dural punctures, or nerve injuries. During follow-up, 69 (41.6%) of 166 previously nonoperated lumbar disc plus radiculopathy patients underwent discectomy at a median time of 128 days (interquartile range, 76–235 days) after first injection. Degrees of straight-leg raising at presentation was significantly associated with subsequent discectomy. On follow-up, patients who did and did not undergo discectomy had low pain scores and high function scores.

Conclusions Children and adolescents can receive ESIs under conscious sedation with good safety. Further prospective studies may better define the role for these injections in the comprehensive management of pediatric spinal pain disorders.

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  • Dr Rodriguez is now with the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA.

    Dr Mooney is now with the Department of Anesthesiology, Penn State Milton S. Hershey Medical Center, Hershey, PA.

    The authors declare no conflict of interest.

    This study was supported by the Sara Page Mayo Endowment for Pediatric Pain Research and Treatment.

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