scholarly journals Inadvertent Discogram During Lumbar Interlaminar Epidural Steroid Injection

2020 ◽  
pp. 103-110
Author(s):  
Philip J. Koehler III
Keyword(s):  
Case Report ◽  
Rare Complication ◽  
Radicular Pain ◽  
Thrombin Inhibitors ◽  
Direct Thrombin Inhibitors ◽  
Ischemic Pain ◽  
Epidural Steroid Injections ◽  
Interlaminar Epidural Steroid Injection ◽  
Epidural Steroid ◽  
Key Words Anticoagulation

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

scholarly journals Successful Spinal Cord Stimulator Trial Placement in a Patient with Presumed Heparin-Induced Thrombocytopenia Treated with Argatroban: A Case Report

2020 ◽  
pp. 61-64
Author(s):  
Ravneet Bhullar
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Cervical Spinal Cord ◽  
Thrombin Inhibitors ◽  
Direct Thrombin Inhibitors ◽  
Spinal Cord Stimulator ◽  
Ischemic Pain ◽  
Heparin Infusion ◽  
Heparin Induced Thrombocytopenia ◽  
Spinal Hematoma

Background: Interventional pain procedures such as spinal cord stimulator placement are safely performed when anticoagulation medications are discontinued beforehand in accordance with published recommendations. However, current guidelines for direct thrombin inhibitors are limited to dabigatran, rivaroxaban, apixaban, and edoxaban. One recommendation is to allow a 5-half-life interval between discontinuation of these medications and a high-risk interventional spine procedure to avoid complications such as spinal hematoma. Case Report: We report a case of a 53-year-old woman with multiple comorbidities who was placed on a heparin infusion after presenting with acute radial artery occlusion and right hand ischemia. The patient underwent vascular bypass of the right arm and then developed compartment syndrome postoperatively, which was treated via fasciotomy. The patient subsequently developed heparin-induced thrombocytopenia and began argatroban for anticoagulation. The patient developed severe right upper extremity ischemic pain, but both medical management and treatment via peripheral nerve catheters failed to control her pain. A cervical spinal cord stimulator trial was placed. The patient did not report significant pain relief after 7 days, so the spinal cord stimulator was removed. Five half-lives were used for discontinuation of argatroban before both spinal cord stimulator trial lead placement and removal. Five half-lives were also used for restarting argatroban following these procedures. No complications were seen with the placement or removal of spinal cord stimulator leads. Conclusion: This case report demonstrates that discontinuing argatroban 5 half-lives before cervical spinal cord stimulator trial placement can be done safely in this patient population and reveals the need for larger case studies to provide additional evidence for guideline recommendations. Key words: Anticoagulation guidelines, direct thrombin inhibitors, interventional pain, interventional spine, ischemic pain, neuromodulation

scholarly journals Complex Regional Pain Syndrome Type II After Cervical Interlaminar Epidural Injection

2021 ◽  
pp. 213-217
Keyword(s):  
Case Report ◽  
Complex Regional Pain Syndrome ◽  
Nerve Root ◽  
Stellate Ganglion ◽  
Stellate Ganglion Block ◽  
Pain Syndrome ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Nerve Root Injury ◽  
Epidural Steroid

BACKGROUND: Complex regional pain syndrome (CRPS) is a pain condition associated with autonomic and inflammatory features and is characterized by pain that is disproportionate in magnitude to the typical pain after similar injuries. The pathophysiology of CRPS is poorly understood, and many events have been implicated as causative factors. CASE REPORT: There are 2 previously documented case reports of CRPS after epidural steroid injections (ESI). This case report details the development of CRPS symptoms in a patient after receiving a cervical ESI. The precipitating event could have been trauma to a nerve root, nerve root irritation from the injectate, or contrast media reaction. Treatment focused on physical therapy and early intervention with a stellate ganglion block. The patient had complete resolution of her symptoms after 10 months. CONCLUSIONS: Although rare, CRPS due to direct nerve root injury or nerve root irritation can develop after an ESI; early diagnosis and treatment may result in a better outcome. KEY WORDS: Complex regional pain syndrome, CRPS, epidural steroid injections, TFESI, ILESI

Repeat epidural steroid injections for radicular pain due to lumbar or cervical disc herniation

2018 ◽  
Vol 100-B (10) ◽  
pp. 1364-1371 ◽  
Author(s):  
H. Joswig ◽  
A. Neff ◽  
C. Ruppert ◽  
G. Hildebrandt ◽  
M. N. Stienen
Keyword(s):  
Functional Outcome ◽  
Disc Herniation ◽  
Radicular Pain ◽  
Cervical Disc Herniation ◽  
Cervical Disc ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Arm Pain ◽  
One Year ◽  
Epidural Steroid

AimsThe aim of this study was to determine the efficacy of repeat epidural steroid injections as a form of treatment for patients with insufficiently controlled or recurrent radicular pain due to a lumbar or cervical disc herniation.Patients and MethodsA cohort of 102 patients was prospectively followed, after an epidural steroid injection for radicular symptoms due to lumbar disc herniation, in 57 patients, and cervical disc herniation, in 45 patients. Those patients with persistent pain who requested a second injection were prospectively followed for one year. Radicular and local pain were assessed on a visual analogue scale (VAS), functional outcome with the Oswestry Disability Index (ODI) or the Neck Pain and Disability Index (NPAD), as well as health-related quality of life (HRQoL) using the 12-Item Short-Form Health Survey questionnaire (SF-12).ResultsA second injection was performed in 17 patients (29.8%) with lumbar herniation and seven (15.6%) with cervical herniation at a mean of 65.3 days (sd 46.5) and 47 days (sd 37.2), respectively, after the initial injection. All but one patient, who underwent lumbar microdiscectomy, responded satisfactorily with a mean VAS for leg pain of 8.8 mm (sd 10.3) and a mean VAS for arm pain of 6.3 mm (sd 9) one year after the second injection, respectively. Similarly, functional outcome and HRQoL were improved significantly from the baseline scores: mean ODI, 12.3 (sd 12.4; p < 0.001); mean NPAD, 19.3 (sd 24.3; p = 0.041); mean SF-12 physical component summary (PCS) in lumbar herniation, 46.8 (sd 7.7; p < 0.001); mean SF-12 PCS in cervical herniation, 43 (sd 6.8; p = 0.103).ConclusionRepeat steroid injections are a justifiable form of treatment in symptomatic patients with lumbar or cervical disc herniation whose symptoms are not satisfactorily relieved after the first injection. Cite this article: Bone Joint J 2018;100-B:1364–71.

Cervical Interlaminar Epidural Steroid Injection Complications Resulting in Monoplegia and Pneumocephalus: A Case Report

PM&R ◽  
2013 ◽  
Vol 5 ◽  
pp. S294-S294
Author(s):  
Nancy Vuong ◽  
Matthew B. McAuliffe ◽  
Adam E. Flanders ◽  
Michael K. Mallow ◽  
Adam L. Schreiber
Keyword(s):  
Case Report ◽  
Steroid Injection ◽  
Epidural Steroid Injection ◽  
Interlaminar Epidural Steroid Injection ◽  
Epidural Steroid

scholarly journals What Is the Role of Epidural Steroid Injections in Lumbar Spinal Disease with Moderate Disability?

2016 ◽  
Vol 4;19 (4;5) ◽  
pp. 293-298
Author(s):  
Jae-Young Hong
Keyword(s):  
Steroid Injection ◽  
Radicular Pain ◽  
Epidural Steroid Injection ◽  
Spinal Disease ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Pain Scores ◽  
One Year ◽  
Lumbar Spinal ◽  
Epidural Steroid

Epidural steroid injections have been gaining popularity as an alternative to surgical treatment of radicular pain with associated spinal derangement. To determine the effectiveness and indications of lumbar epidural steroid injections in patients with or without surgery, we performed a prospective observational study. We gathered data from 262 degenerative short-segment spinal disease patients (affected at one or 2 levels) with greater than 12 weeks of medication-resistant radicular pain without neurological deficits but with moderate disability (visual analog scale < 6.5; Oswestry Disability Index < 35). All patients received initial fluoroscopically guided transforaminal epidural steroid injections of the affected vertebral level(s) corresponding to their symptoms. Those with inadequate responses or who wanted subsequently surgery underwent decompression surgery. Clinical and demographic characteristics were assessed to compare the differences between the groups. Results: Of the 262 patients who received epidural steroid injections, 204 did not have operations for up to one year. However, 58 patients experienced inadequate relief of pain or wanted operations and therefore underwent surgery. At baseline, the 2 groups had similar mean disability indices and pain scores, as well as gender ratios, ages, and durations of symptoms (P > 0.05). In the patients who underwent surgery, the mean disability and pain scores were not significantly decreased after injection compared to those in the injection-alone group, although the scores for the injection plus surgery patients decreased significantly after surgery (P < 0.05). In contrast, patients who underwent epidural steroid injection alone experienced a significant decrease in disability and pain after injection, and that persisted up to one year of follow-up (P < 0.05). Epidural steroid injection can decrease the pain and disability in the majority of a moderate disability group for up to one year, although a significant number of patients underwent surgery regardless of injection. We recommend epidural steroid injection as a first-line treatment in patients with moderate disability that can be converted to surgery without significant delay. Key words: Epidural steroid injection, spinal surgery, lumbar spinal disease, lumbar radiculopathy, lumbar radicular pain

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