Title: Incidental discogram during an attempted lumbar transforaminal epidural steroid injection
Abstract: A 69-year-old female presented to the Institute for Pain Medicine, Western Pennsylvania hospital, Pittsburgh, with a 3 month history of low back pain radiating to her right lower extremity. She also had tingling and numbness in the right leg. Her description of pain and numbness corresponded to the right L4 distribution. However her Lumbar MRI scan showed a moderate to severe right sided disk herniation at the level of L5-S1 causing impingement of the right L5 nerve root. The MRI also showed a moderate right sided disc protrusion at the L4-L5 level. She failed conservative management with physical therapy and NSAIDs. Given the patient's symptoms and physical examination findings consistent with a right L 4 radiculopathy, the plan was made to proceed with a right L4 transforaminal epidural steroid injection under fluoroscopic guidance. The procedure was performed by an experienced interventional pain physician. Fluoroscopic guidance was used to guide a 22 gauge needle to the L4-5 nerve root foramen in the oblique view. Contrast material was then used to delineate the nerve root to confirm the needle placement. The injected contrast material however delineated the L4-5 disc producing an incidental discogram. The needle was then repositioned to the upper part of the neural foramen and contrast was injected. The contrast delineated the epidural space and the right L4 nerve root. Following this a successful right L4 transforaminal epidural steroid injection was performed. The patient noted 100% pain relief on follow up. It was felt that the patient most likely had an annular tear with moderate to severe degree of disk bulge extending into the right neural foramen at the L4-5 level into which the contrast had entered on the first attempt producing an incidental discogram.
Publication Year: 2010
Publication Date: 2010-04-01
Language: en
Type: article
Indexed In: ['crossref']
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