scholarly journals Phantom Radiculitis Effectively Treated by Fluoroscopically Guided Transforaminal Epidural Steroid Injections

2010 ◽  
Vol 6;13 (6;12) ◽  
pp. 505-508
Author(s):  
Gerard DeGregoris
Keyword(s):  
Lower Extremity ◽  
Phantom Limb Pain ◽  
Spinal Nerve ◽  
Phantom Limb ◽  
Limb Pain ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Epidural Steroid ◽  
Radicular Compression ◽  
New Onset

Lower back and extremity pain in the amputee patient can be challenging to classify and treat. Radicular compression in a patient with lower limb amputation may present as or be superimposed upon phantom limb pain, creating diagnostic difficulties. Both patients and physicians classically find it difficult to discern phantom sensation from phantom limb pain and stump pain; radicular compression is often not considered. Many studies have shown back pain to be a significant cause of pain in lower limb amputees, but sciatica has been rarely reported in amputees. We present a case of L4/5 radiculitis in an above-knee amputee presenting as phantom radiculitis. Our patient is a 67 year old gentleman with new onset 10/10 pain in a phantom extremity superimposed upon a 40 year history of previously stable phantom limb pain. MRI showed a central disc herniation at L4/5 with compression of the traversing left L4 nerve root. Two fluoroscopically guided left transforaminal epidural steroid injections at the level of the L4 and L5 spinal nerve roots totally alleviated his new onset pain. At one year post injection, his phantom radiculitis pain was completely gone, though his underlying phantom limb pain remained. Lumbar radiculitis in lower extremity amputee patients may be difficult to differentiate from baseline phantom limb pain. When conservative techniques fail, fluoroscopically guided spinal nerve injection may be valuable in determining the etiology of lower extremity pain. Our experience supports the notion that epidural steroid injections can effectively treat phantom lumbar radiculitis in lower extremity amputees. Key words: amputee, phantom pain, phantom sensation, phantom radiculitis, disc herniation, interlaminar, transforaminal, epidural steroid injection

Percutaneous Treatments for Residual and/or Phantom Limb Pain in Adults with Lower‐Extremity Amputations: A Narrative Review

PM&R ◽  
2021 ◽  
Author(s):  
Beau P. Sperry ◽  
Cole W. Cheney ◽  
Keith T. Kuo ◽  
Nathan Clements ◽  
Taylor Burnham ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Phantom Limb Pain ◽  
Narrative Review ◽  
Phantom Limb ◽  
Limb Pain

scholarly journals Very early phantom limb pain following amputation of a lower extremity: Case report

2013 ◽  
Vol 41 (3) ◽  
pp. 236-239 ◽  
Author(s):  
Adriana Margarita Cadavid Puentes ◽  
Eliana Maria Castañeda Marin
Keyword(s):  
Case Report ◽  
Lower Extremity ◽  
Phantom Limb Pain ◽  
Phantom Limb ◽  
Limb Pain

scholarly journals Efficacy of epidural injection of steroid in treatment of lumber disc prolapse: article review

2021 ◽  
Vol 8 (1) ◽  
pp. 10-19
Author(s):  
Musaed hekmat AL-Dahhan
Keyword(s):  
Lower Extremity ◽  
Disc Herniation ◽  
Epidural Injection ◽  
Low Back ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Lower Extremity Pain ◽  
Epidural Steroid ◽  
Caudal Epidural ◽  
Corticosteroid Injections

"Chronic low back and lower extremity pain is mainly caused by lumbar disc herniation (LDH) and radiculitis. Various surgery and nonsurgical modalities, including epidural injections, have been used to treat LDH or radiculitis. Caudal epidural injection of local anesthetics with or without steroids is one of the most commonly used interventions in managing chronic low back and lower extremity pain. To describe the indications, rationale, techniques, alternatives, contraindications, complications, and efficacy of lumbar and caudal epidural corticosteroid injections. Interventions: Three reviewers with formal training and certification in evidence-based medicine searched the literature on non–image guided lumbar interlaminar epidural steroid injections. A larger team of seven reviewers independently assessed the methodology of studies found and appraised the quality of the evidence presented. A systematic literature search was performed, in the Medline Case reports and retrospective and prospective studies were extensively reviewed to provide detailed descriptions of the clinical features of lumbar and caudal epidural corticosteroid injections. Data sources included relevant literature of the English language identified through searches of PubMed and EMBASE , and manual searches of bibliographies of known primary and review articles. Epidural corticosteroid injections are commonly requested treatments for patients with various low-back or lower-extremity pain syndromes (or both). Most of the reports on the use of this type of treatment are retrospective and noncontrolled. These studies indicate benefit; however, the prospective controlled studies provide varied results about the efficacy of lumbar and caudal epidural corticosteroid injections. In conclusions: In patients with lumbar radicular pain secondary to disc herniation or neurogenic claudication due to spinal stenosis, interlaminar epidural steroid injections appear to have clinical effectiveness limited to short-term pain relief. Therefore, in a contemporary medical practice, these procedures should be restricted to the rare settings where fluoroscopy is not available."

scholarly journals Digital Subtraction Angiography Does Not Reliably Prevent Paraplegia Associated with Lumbar Transforaminal Epidural Steroid Injection

2012 ◽  
Vol 6;15 (6;12) ◽  
pp. 515-523
Author(s):  
Kenneth D. Candido
Keyword(s):  
Spinal Cord ◽  
Pain Relief ◽  
Lower Extremity ◽  
Digital Subtraction Angiography ◽  
Test Dose ◽  
Spinal Cord Infarction ◽  
Digital Subtraction ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Epidural Steroid

Digital subtraction angiography (DSA) has been touted as a radiologic adjunct to interventional neuraxial procedures where it is imperative to identify vascular compromise during the injection. Transforaminal epidural steroid injections (TFESI) are commonly performed interventions for treating acute and chronic radicular spine pain. We present a case of instantaneous and irreversible paraplegia following lumbar TFESI wherein a local anesthetic test dose, as well as DSA, were used as adjuncts to fluoroscopy. An 80-year-old man with severe lumbar spinal stenosis and chronic L5 radiculopathic pain was evaluated at a university pain management center seeking symptomatic pain relief. Two prior lumbar interlaminar epidural steroid injections (LESI) provided only transient pain relief, and a decision was made to perform right-sided L5-S1 TFESI. A 5-inch, 22-gauge Quincke-type spinal needle with a curved tip was used. Foraminal placement of the needle tip was confirmed with anteroposterior, oblique, and lateral views on fluoroscopy. Aspiration did not reveal any blood or cerebrospinal fluid. Digital subtraction angiography was performed twice to confirm the absence of intravascular contrast medium spread. Subsequently, a 0.5mL of 1% lidocaine test dose was performed without any changes in neurological status. Two minutes later, a mixture of one mL of 1% lidocaine with 80 mg triamcinolone acetonide was injected. Immediately following the completion of the injection, the patient reported extreme bilateral lower extremity pain. He became diaphoretic, followed by marked weakness in his bilateral lower extremities and numbness up to his lower abdomen. The patient was transferred to the emergency department for evaluation. Magnetic resonance imaging (MRI) of the lumbar and thoracic spine was completed 5 hours postinjection. It showed a small high T2 signal focus in the thoracic spinal cord at the T7-T8 level. The patient was admitted to the critical care unit for neurological observation and treatment with intravenous methylprednisolone. Follow-up MRI revealed a hyper-intense T2 and short-tau inversion recovery signal in the central portion of the spinal cord beginning at the level of the T6 superior endplate and extending caudally to the T9-T10 level with accompanying development of mild spinal cord expansion. The patient was diagnosed with paraplegia from acute spinal cord infarction. At discharge to an acute inpatient rehabilitation program, the patient had persistent bilateral lower extremity paralysis, and incontinence of bowel and bladder functions. In the present patient, DSA performed twice and an anesthetic test dose did not prevent a catastrophic spinal cord infarction and resulting paraplegia. DSA use is clearly not foolproof and may not be sufficient to identify potentially life-or-limb threatening consequences of lumbar TFESI. We believe that this report should open further discussion regarding adding the possibility of these catastrophic events in the informed consent process for lumbar TFESIs, as it has for cervical TFESI. Utilizing blunt needles or larger bevel needles in place of sharp, cutting needles may minimize the chances of this event occurring. Considering eliminating use of particulate steroids for TFESI should be evaluated, although the use of nonparticulate agents remains controversial due to the perception that their respective duration of action is less than that of particulate steroids. Key words: Digital subtraction angiography, transforaminal epidural steroid injections, paraplegia, chronic low back pain.

Very early phantom limb pain following amputation of a lower extremity: Case report☆

2013 ◽  
Vol 41 (3) ◽  
pp. 236-239
Author(s):  
Adriana Margarita Cadavid Puentes ◽  
Eliana Maria Castañeda Marin
Keyword(s):  
Case Report ◽  
Lower Extremity ◽  
Phantom Limb Pain ◽  
Phantom Limb ◽  
Limb Pain
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