818 - Narrative Review: Granuloma-Like Reaction after Injection of Particulate Steroids, Potential Implications for Interlaminar Epidural Corticosteroid Injections

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

DE

Deion Ellis, MD, MMS

Preliminary Intern
University of New Mexico (Prelim)/University of Colorado (PM&R)
Albuquerque, New Mexico, United States

Co-Author(s)

LD

Lillian Dennison, BA

MD Candidate
University of New Mexico School of Medicine
Albuquerque, New Mexico, United States
RE

Reza Ehsanian, MD/PhD

Vice Chair of Clinical Research and Assistant Professor
Department of Anesthesiology & Critical Care Medicine, University of New Mexico School of Medicine
Albuquerque, New Mexico, United States
JB

Jordan A. Buttner, BS

MD Candidate
University of New Mexico School of Medicine
Albuquerque, New Mexico, United States
BS

Byron Schneider, MD

Associate Professor
Department of Physical Medicine and Rehabilitation, Vanderbilt University
Nashville, Tennessee, United States
BS

Byron Stephens, MD

Associate Professor
Department of Orthopaedic Surgery, Vanderbilt University
Nashville, Tennessee, United States
David J. Kennedy, MD

Professor and Chair
Department of Physical Medicine and Rehabilitation, Vanderbilt University
Nashville, Tennessee, United States
Aaron Yang, MD

Associate Professor
Vanderbilt University Medical Center
Nashville, Tennessee, United States

Objectives: To present a review of literature on alterations after particulate corticosteroid injections.

Design: Narrative Review

Participants:

The studies selected (N=14) consisted of patients who showed systemic and local reactions after receiving injections with particulate steroids (N=441).

Main outcome measure:

Incidental systemic and local reactions to particulate corticosteroid injections.

Results: Our narrative review yielded limited literature on systemic and local effects of particulate steroid injections. We initially identified 161 manuscripts from PubMed MEDLINE, Ovid MEDLINE, EMBASE, and Google Scholar spanning 1961-2023. After relevance screening and deduplication, 133 articles were left for full-text review by two reviewers. We ultimately included 14 articles meeting PICOS criteria, encompassing 441 patients. Primary systemic reactions were transient headaches, while common local reactions included skin atrophy and hypopigmentation. Histological changes were mostly reported in dermatologic literature. Five articles reported granulomatous-like reactions in 41 patients following particulate steroid injections, resulting in particulate formation at the injection site.

Conclusions: An extensive review of existing literature reveals no reports of epidural reactions after ILPESI. When comparing the cases of granuloma-like reactions in the literature to those of our ILPESI case series, it led to the conclusion that there may be a potential for the development of granuloma-like particulates in the epidural space after ILPESI. These findings warrant further research on the causes and potential clinical implications of this phenomenon.