Interventional Spine Considerations for Radiosensitivity in a Patient with Ligase IV Syndrome

Background: Patient selection plays a critical role in any interventional pain practice. Rare conditions may not always have clearly established guidelines for interventional pain procedures. Ligase IV (LIG4) syndrome is a rare inherited condition with a wide variety of features, including radiosensitivity..Case Report: A 36-year-old woman with a known history of LIG4 syndrome presented with an acute on chronic left L5 and S1 radiculopathy from a large L5-S1 central disc herniation. In an effort to minimize radiation exposure, an ultrasound (US)-guided caudal epidural steroid injection was used to help manage her radicular leg pain.Conclusion: Interventional spine providers should be aware of rare radiosensitive conditions and strive to offer appropriate treatment alternatives. While limitations do exist, emerging US-guide spine procedures hold a distinct advantage for patients with radiosensitivities.Key words: Epidural steroid injection, Ligase IV syndrome, radiculopathy, radiology, radiosensitivity, ultrasound