Document Detail

Inadvertent disk injection during transforaminal epidural steroid injection: steps for prevention and management.
MedLine Citation:
PMID:  18657222     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: To report two cases of disk injection during transforaminal epidural steroid injection, and to discuss ways to prevent and manage this under-appreciated complication. DESIGN: Case reports and literature reviews. PATIENTS: Two patients with radicular symptoms underwent transforaminal epidural steroid injections under fluoroscopic guidance. The needle in both cases was placed in the center of the intervertebral foramen, about 1 cm above the inferior endplate. Injection of contrast in both cases revealed diskographic spread. Repeat magnetic resonance imaging revealed a large foraminal disk herniation in both patients. RESULTS: A literature search identified three studies whereby the use of a single-needle technique to perform diskography was clearly noted in conjunction with the number of infectious complications. Comparing these data with the incidence of diskitis when a double-needle approach was used found the infectious risk to be considerably higher. There are no data regarding whether imaging studies affect outcomes following epidural steroid injections. CONCLUSIONS: These cases and similar complications following transforaminal epidural steroid injections provide anecdotal evidence that recent imaging studies, repeated not only for qualitatively new symptoms but after a sustained quantitative increase in pain, may reduce the complication risk. Data extrapolated from studies on diskitis suggest that administering parenteral, and possibly also intradiskal antibiotics, immediately after inadvertent disk injection is appreciated, may reduce the infectious risk.
Steven P Cohen; David N Maine; Sean M Shockey; Sapna Kudchadkar; Scott Griffith
Publication Detail:
Type:  Case Reports; Journal Article; Research Support, Non-U.S. Gov't; Review     Date:  2008-07-24
Journal Detail:
Title:  Pain medicine (Malden, Mass.)     Volume:  9     ISSN:  1526-4637     ISO Abbreviation:  Pain Med     Publication Date:  2008 Sep 
Date Detail:
Created Date:  2008-09-25     Completed Date:  2009-04-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100894201     Medline TA:  Pain Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  688-94     Citation Subset:  IM    
Department of Anesthesiology and Critical Care Medicine, Pain Management Division, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
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MeSH Terms
Analgesia, Epidural / adverse effects*
Disease Management
Epidural Space / drug effects,  radiography
Foramen Magnum / drug effects*,  radiography
Injections, Epidural / adverse effects
Intervertebral Disk / drug effects*,  radiography
Low Back Pain / drug therapy,  radiography
Steroids / administration & dosage*
Reg. No./Substance:
Comment In:
Pain Med. 2009 Jan;10(1):194   [PMID:  19222781 ]
Pain Med. 2009 Jan;10(1):193   [PMID:  19222780 ]

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