Open AccessInadvertent Discogram During Lumbar Interlaminar Epidural Steroid Injection
Author(s) -
Philip J. Koehler
Publication year - 2020
Publication title -
interventional pain management reports
Language(s) - English
Resource type - Journals
ISSN - 2575-9841
DOI - 10.36076/pmcr.2020/4/103
Subject(s) - epidural steroid injection , medicine , radicular pain , lumbosacral joint , surgery , complication , lumbar , low back pain , magnetic resonance imaging , epidural space , anesthesia , radiology , alternative medicine , pathology
Background: Interlaminar epidural steroid injections (ILESI) are the most common injection performed for lumbosacral radicular pain. In order to continually improve the performance and safety profile of ILESI, it is imperative to report complications and inadvertent outcomes in addition to studies on efficacy in order to create guidelines to mitigate risk of potential debilitating sequelae.Case Report: Here we present a case report of a 36-year-old man who underwent a right sided ILESI for right sided lumbosacral radicular pain from a disc herniation. Following the injection, he had complete resolution of right sided symptoms. However, 4 weeks later he developed left sided lumbosacral radicular for which he underwent repeat left sided ILESI that resulted in an inadvertent discogram. Following this procedure a new magnetic resonance image was obtained that revealed a new large left L5-S1 paracentral extrusion with caudal migration of disc material abutting the ligamentum flavum in the path of the left-sided injection attempt. The patient was treated with oral antibiotics and suffered no significant sequelae from the inadvertent discogram.Conclusions: Discogram during ILESI is a highly unusual and rare complication. We discuss the management and prevention of this complication and review the limited existing literature.Key words: Anticoagulation guidelines, direct thrombin inhibitors, interventional pain, interventional spine, ischemic pain, neuromodulation