Las pruebas disponibles son insuficientes para determinar los efectos relativos de las inyecciones de médula ósea versus de esteroides, aunque las inyecciones de médula ósea son más invasivas. Es interesante destacar que la tasa de curación del quiste óseo según la evaluación radiográfica a los dos años estuvo muy por debajo del 50% para ambas intervenciones. En términos generales, hay una falta de pruebas para determinar el mejor método de tratamiento de los quistes óseos simples de huesos largos en niños. Se necesitan más ECA de tamaño y calidad suficientes para guiar la práctica clínica.
Epidural steroid injections are most commonly used in situations of radicular pain, which is a radiating pain that is transmitted away from the spine by an irritated spinal nerve. Irritation of a spinal nerve in the low back ( lumbar radiculopathy ), such as from lumbar spinal stenosis , cervical spinal stenosis, herniated disc , and foraminal encroachment, causes back pain that goes down the leg. Epidural injection is also used as a minimally invasive procedure to treat nerve compression in the neck (cervical spine), referred to as cervical radiculopathy , which causes pain.
I started losing my sense of smell again in February, and by April I was anosmic again. I did get it back, partially and intermittently, for about ten days after I used a Nasacort inhaler from my stash (they no longer sell them), and then I became anosmic again. On the 16 th of June, 2004, I got another Kenalog injection, on the left side, in preparation for my trip to Austin, Texas, to visit my daughter Lotus. The Kenalog effected a restoration of my sense of smell more rapidly than usual this time. The very next day the grocery store was a scent carnival -- every few steps brought a new, intense odor (most pleasant, some not). Walking through my garden I brushed against the dill plants and the scent was delightfully intense. As I weeded my flower beds the next day I could smell the marigolds and several of the weeds I pulled. The Datura was stinky and the rosemary delightful. Getting one's sense of smell back after a period of anosmia is a real trip! My Seventh Kenalog Injection, June, 2005 Having been congested for a good while, I went in to see my doc on the 27 th of June, 2005. He scoped my nose, found no polyps there, and ordered a Kenalog injection for me so I should be able to enjoy my July vacation. He advised me that we can also try, once the Kenalog has worn off, Astelin , an antihistamine nasal spray which is prescribed for vasomotor rhinitis (including nasal congestion). June, 2007 My sense of smell is still good, two years after my last Kenalog injection. I have been stuffy, but not anosmic. I am using Astelin now during the pollen season. It seems to help a bit, but I am still more congested than I'd like to be. The Down Side of Steroid Use Although I have observed no undesirable side effects of my Kenalog injections, it is well known that there is a long list of such possible side effects, contraindications, and complications. One correspondent reported to me that he had suffered tissue loss at the site of the injection. Apparently he had successive injections in the same site. My nurse rotates the site of injection to reduce that possibility. Some physicians are reluctant to use steroid therapy, others not. Another of my correspondents, who is a practicing physician, wrote to me " The role of steroids in treatment of all types of respiratory inflammatory problems has really changed over the past 5-10 years with much earlier initiation and better/quicker resolution. There does not seem to be much long term down side to the use of a short course of systemic steroids."