Open AccessDural Puncture and Subdural Injection: A Complication of Lumbar Transforaminal Epidural Injections
Author(s) -
Bradly S. Goodman
Publication year - 2007
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2007/10/697
Subject(s) - medicine , epidural steroid injection , complication , surgery , subdural space , epidural space , post dural puncture headache , lumbar , context (archaeology) , intrathecal , anesthesia , lumbar puncture , low back pain , hematoma , cerebrospinal fluid , spinal anesthesia , paleontology , alternative medicine , pathology , biology
Case Report: Two cases are presented in which the complication of duralpuncture is documented in the context of a lumbar transforaminal epiduralsteroid injection. The hazard of dural puncture during transforaminal epiduralinjections, the anatomy of the dural and thecal sac, the potential for subduralinjections, and relevant literature are reviewed.Design: Report of two cases.Background: Lumbar transforaminal epidural steroid injections are a commonly employed procedure for the treatment of lumbar radiculopathy. Theoptimal target point lies at the “6 o’ clock” position of the pedicle. Contrastis injected to confirm proper placement of the needle and correct flow of themedication through the epidural space. Despite apparent proper placementof the needle, a potential complication exists of puncturing the dura whileperforming this procedure. Spinal injectionists should recognize the subsequent contrast patterns associated with this complication.Conclusion: Subdural and intrathecal spread of contrast is rarely seen withtransforaminal injections and thus can be easily overlooked. Becoming familiar with the images presented in these cases may help alert the interventionalist of a dural puncture, and thus avoid injection of medications into the intrathecal and subdural spaces.Key words: Back pain, epidural steroid injection, subdural, intrathecal