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Epidural blockade is becoming one of the most useful and versatile procedures in modern anaesthesiology. What is unique is its application to clinical practice, as it can be placed virtually at any spinal level of vertebral column that allows considerable flexibility. Epidural steroid injections through lumbar transforaminal route to treat pain in lower back where radiculopathy is also associated with, are used widely. It has been reported that these procedures in lumber spine are effective clinically for improved physical function in patients as well as relief of pain of short- and long-term duration. We wanted to determine as to whether there is a difference in the efficacy between nonparticulate (e.g. dexamethasone phosphate) and particulate (e.g. triamcinolone acetate) steroids in Lumbar Epidural via transforaminal approach for acute radicular pain in lumber region and adverse effects of the drugs if any. METHODS66 patients, 33 in each group, with dexamethasone phosphate 8 mg or triamcinolone acetate 40 mg for lumbar transforaminal approach epidural steroid injection, were randomized. Observation was done through visual analog scale, short McGill pain questionnaire, revised Oswestry Disability Index before intervention and a month later. RESULTSA difference which was significant statistically in the visual analog score (2.85 ± 0.83 in group T, 5.76 ± 0.75 in group Dx), McGill Pain Questionnaire (3.73 ± 1.15 in group T, 6.55 ± 0.51 in group Dx) and Oswestry Disability Index (18.67 ± 7.13 in group T, 35.83 ± 5.10 in group Dx ) was found in both but was more in triamcinolone group. CONCLUSIONSEfficacy is more in particulate (triamcinolone) than non-particulate (dexamethasone) in epidural injection through lumbar transforaminal with no drug related complication, performed for radiculopathy in lumbar region.
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Coronary arteries supply blood to the heart. They run through the epicardial adipose tissue during their course. Occasionally a band of myocardial tissue overlies a segment of the coronary arteries. This band of myocardium overlying the coronary artery is named as Myocardial Bridge (MB). There have been numerous instances of sudden and unexpected cardiac death where the presentation of myocardial bridging was the main clinically pertinent finding post-mortem. We wanted to study the distinct morphological aspects of MBs along with the structural composition of the coronary vessel present beneath, in front of and past the myocardial bridge. METHODSMicroscopy and morphometry were utilized to detail the distinct morphological characteristics of myocardial bridges as well as to take a closer look at the structural composition of the coronary vessel present beneath, in front of and past the myocardial bridge being evaluated. Three segments of the left anterior descending artery (LAD) were utilized to glean testable samples. These samples are as follows: (A) located proximally to the bridge at a distance of 8 mm, (B) alongside the bridge and (C) located distally from the bridge at a distance of 8 mm. RESULTSPrevalence of MB was found to be 40 %. Male to female ratio was 7:1. 87.5 % of the hearts have single MB, 10 % have double MB, 2.5 % have triple MB. Most common vessel affected is LAD. The MBs ranged in length from 4.4 mm to 45 mm with a length of 12.67 mm being the quantifiable mean. Thickness of MB ranged from 0.4 to 1.9 mm with mean thickness of 1.11 mm. The component of the coronary artery that was bridged often showed a diminished tunica intima compared to similar segments taken from proximal and distal sites. It should be noted that the proximal segment is predisposed to atherosclerotic presentation on account of myocardial bridging. CONCLUSIONSA myocardial bridge leads to detrimental changes in the vessel which in turn leads to early presentation of atherosclerosis, arrhythmias, myocardial infarctions and in severe cases, sudden death. Myocardial bridging is frequently localized in the LAD. It can have significant effects on the overall health.
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Objective:To observe the feasibility and accuracy of ultrasound-guided transforaminal epidural injection. Methods:Ultrasound-guided injection at L1-2, L2-3, L3-4, L4-5, L5-6 bilaterally was performed in L1-6 spine from two Bama miniature pigs. The position of needles was detected with X-ray and CT, and observed under anatomy. The distance from the puncturing points at skin to the posterior midline, the depths and angles of puncturing between were measured and compared bilaterally. Results:The successful rate was 95% (19/20), out of which, 80% (16/20) were put the needle tips at the lower part of the intervertebral foramen, ventral side, central region or paracentral region. There was no significant difference between sides in the distances, depths or angles in 19 successful injections. Conclusion:It is accurate to transforaminally puncture under ultrasound-guided.
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OBJECTIVE@#To evaluate the efficacy of lumbar transforaminal epidural block (LTEB) for treatment of low back pain with radicular pain.@*METHODS@#We retrospectively analyzed the clinical data of 78 patients with low back pain and radicular pain admitted to the Department of Orthopedics of Beijing Chuiyangliu Hospital from March, 2017 to April, 2019. Thirty-three of the patients received treatment with LTEB (LTEB group), and 45 received comprehensive conservative treatment including traction, massage, acupuncture and physiotherapy (control group). The demographic and clinical data of the two groups were compared. The patients were followed up for 3 to 24 months, and numerical rating scale (NRS) and Oswestry disability index (ODI) scores of the patients were evaluated before the treatment and at 2 weeks, 1 month and 3 months after discharge to assess the efficacy of the treatment.@*RESULTS@#The mean operation time of LTEB was 25.7 7.5 min (15-45 min). After the operation, 5 patients developed weakness of the lower limbs but all recovered within 24-72 h. The patients receiving LTEB all showed significantly decreased NRS scores for low back and radicular pain and ODI scores after the operation (@*CONCLUSIONS@#As a minimally invasive approach, LTEB is effective for treatment of low back pain with radicular pain and can produce good short-term effects of pain relief and functional improvement.
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Humans , Injections, Epidural , Low Back Pain/drug therapy , Lumbar Vertebrae , Radiculopathy/drug therapy , Retrospective Studies , Treatment OutcomeABSTRACT
One of the most commonly employed methods of treatment for Lumbar disc herniation with leg pain is epidural steroid injection. Of the three routes being deployed, inter-laminar approach is preferred as needle entry can be directed more closely to the assumed site of pathology, requiring less volume than the caudal route and it is less risky compared to the trans-foraminal approach. For effective placement of the spinal needle in the epidural space, use of C-arm is a must. But, the operation theatre and C-arm is not available in most of the health centers in the developing countries especially in rural settings. Time taken to set up is another issue. To improve the success rate of needle placement in “blind method” of ILESI, we have developed a technique of using digital X-ray of lumbo-sacral spine, which is available universally nowadays, to measure the depth of the epidural space and level of the targeted inter-vertebral space. Objective: To assess the effectiveness of measurements in plain roentgenograms of lumbo-sacral spine in guiding needle placement into epidural space. Methods: A prospective study was taken up in the Dept. of PMR, JNIMS during the period May 2017- Feb 2018. 56 consecutive clinically diagnosed prolapsed PIVD patients were enrolled. Lengths of spinous process and skin thickness were measured using a caliper. A 22G Quincke needle was advanced to the expected depth given by digital xray measurement. 1 ml of Iohexol dye was injected. Position of needle was checked by C-arm x-ray. Results: Out of the total 56 subjects, 46 (82.1%) completed the treatment program. Needle was placed at proper depth in 36 cases by using Xray measurement, giving success rate of 87.8%. Mean (SD) depth of epidural space from skin was found to be 3.82 (o.74) cm as measured from X-ray and actual measurement confirmed by fluoroscopy was 3.9 (0.81) cm (Pearson’s correlation coefficient =0.86). Conclusion: Measurement of depth of epidural space using plain X-ray of LS spine improves the success rate of blind MILESI from around 50% to 87.8%. This method of non-real time imaging is cost effective in developing countries where C-arm X-ray facilities are not available
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Aim & Objectives: To compared the effect of ketamine and combination of ketamine plus dexamethasone on the duration of postoperative analgesia and to evaluate the effect of dexamethasone on postepidural backache and other complications. Methods: 50 patients (ASA I and II) posted for elective surgery of lower limb in orthopedics, were divided at random into two groups of 25 each. Patients in group I received Inj. Ketamine HCl 0.3 mg/kg diluted in 10 ml normal saline while patients in group II received ketamine HCl 0.3 mg/kg and dexamethasone 8 mg diluted in 10 ml normal saline postoperatively through epidural catheter. The relief of pain and perioperative sequelae were compared. Results: Groups were compared with respect to quality of epiduralanaesthesia and pain relief as felt by the patient. The quality of epidural anaesthesia was found adequate in 80% cases of group 2 and 76% cases of group 1. Pain relief was 20% excellent and 76% good in group 2 and 12% excellent and 68% good in group 1. In group I the mean duration of pain relief after epidural injection of ketamine 0.3 mg/kg was 363.91±180.94 min and in group II after epidural injection of ketamine 0.3 mg/kg with dexamethasone 8 mg was 582.63±182.03 min. These values differ markedly and are statistically highly significant (p<0.001). Conclusion: Ketaminecan be used epidurally safely for rapid onset and is effective for prolonged postoperative analgesia with minimum side effects and high acceptability. The duration can be further prolonged with the addition of dexamethasone and the incidence of postepidural backache is also minimised with dexamethasone.
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Introduction: Sacral hiatus (SH) is a significant landmark during caudal epidural block (CEB) which is employedfor analgesia and anaesthesia during a wide range of clinical conditions. This requires a thorough knowledge ofmorphometric characteristics of SH and surrounding landmarks, but variability in morphometric dimensionsexists among different populations.Aim: The aim of this study was to identify different anatomical landmarks to detect the location of SH andprovide a reference database for morphometric dimensions of SH in Indian population.Materials and Methods: The study was done on 108 dry adult human sacra. Linear measurements of the sacrawere taken with the help of digital vernier caliper and angular parameters were determined with a goniometer.Results: The most common shape of the sacral hiatus was inverted ’V’ shaped (59.3%) with the level of the apexat S4 in 66.7% and base at S5 in 86.1% cases. Morphometric dimensions of SH were found to be smaller in presentstudy as compared to reports by other researchers. Left crest-apex angle was observed to be significantly greaterthan the right crest-apex angle. (p 0.001).Conclusion: Multiple bony landmarks and their morphometric dimensions should be considered to locate the SHduring CEB. Values for various morphometric parameters of SH are less in Indians in comparison to otherpopulations, which should be contemplated during caudal epidural injections and trans-sacral thecaloscopy.
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The approach we suggest was developed for cases in which the fourth and fifth lumbar and first sacral spinal nerves were affected in lumbar degenerative disc disease. Retrodiscal transforaminal epidural injection is known to be very effective for lumbar radiculopathy because of excellent access to primary pathology; however, access below L5 is often restricted by the anatomic characteristics of the L5–S1. In the translateral recess approach (TLR), proper final needle placement (i.e., in the axillary portion between the exiting and traversing nerve roots) can be achieved by setting the direction of the needle laterally and superiorly from the distal tip of the infra-adjacent spinous process toward the medial wall of the pedicle and neural foramen of the given level without neural injury. This approach is possible because of the wide interlaminar space in the L5–S1. Preganglionic epidural injection through TLR is an effective and safe spinal intervention for lumbosacral radiculopathy.
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Injections, Epidural , Needles , Pathology , Radiculopathy , Spinal NervesABSTRACT
BACKGROUND: Lumbosacral transforaminal epidural injection (TFEI) is an effective treatment for spinal disease. However, TFEI may have several types of complications, some of which can be attributed to intravascular injection. We reviewed studies to compare the intravascular injection rate among different needle types. METHODS: We searched the literature for articles on the intravascular injection rate among different needle types used in TFEI. The search was performed using PubMed, MEDLINE, the Cochrane Library, EMBASE, and Web of Science. RESULTS: A total of six studies comprising 2359 patients were identified. Compared with the Quincke needle, the Whitacre needle reduced the intravascular injection rate (OR = 0.57, 95% CI = [0.44–0.73], P < 0.001). However, compared with the Quincke needle, the Chiba needle did not reduce the intravascular injection rate (OR = 0.80, 95% CI = [0.44–1.45], P = 0.46). In one study, the intravascular injection rate using a blunt-tip needle was lower than that using a sharp needle. In another study, the Whitacre and the blunt-tip needle have similar intravascular injection rates, while, the catheter-extension needle showed a reduced intravascular injection rate. CONCLUSIONS: This meta-analysis showed that the Whitacre needle reduced the intravascular injection rate as compared with the Quincke needle, but failed to establish that the Chiba needle can decrease the intravascular injection rate in TFEI. Moreover, the blunt-tip needle can reduce the intravascular injection rate compared with the Quincke needle, and the catheter-extension needle can reduce the intravascular injection rate compared with the Whitacre and the blunt-tip needle.
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Humans , Anesthesia, Epidural , Injections, Epidural , Needles , Spinal DiseasesABSTRACT
BACKGROUND: Patient-controlled epidural analgesia (PCEA) is known to provide good postoperative analgesia in many types of surgery including laparoscopic surgery. However, no study has compared PCEA with patient-controlled intravascular analgesia (PCIA) in laparoscopic radical prostatectomy (LARP). In this study, the efficacy and side effects of PCEA and PCIA after LARP were compared. METHODS: Forty patients undergoing LARP were randomly divided into two groups: 1) a PCEA group, treated with 0.2% ropivacaine 3 ml and 0.1 mg morphine in the bolus; and 2) a PCIA group, treated with oxycodone 1 mg and nefopam 1 mg in the bolus. After the operation, a blinded observer assessed estimated blood loss (EBL), added a dose of rocuronium, performed transfusion, and added analgesics. The numeric rating scale (NRS), infused PCA dose, and side effects were assessed at 1, 6, 24, and 48 h. RESULTS: EBL, added rocuronium, and added analgesics in the PCEA group were less than those in the PCIA group. There were no significant differences in side-effects after the operation between the two groups. Patients were more satisfied with PCEA than with PCIA. The NRS and accumulated PCA count were lower in PCEA group. CONCLUSIONS: Combined thoracic epidural anesthesia could induce less blood loss during operations. PCEA showed better postoperative analgesia and greater patient satisfaction than PCIA. Thus, PCEA may be a more useful analgesic method than PICA after LARP.
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Humans , Administration, Intravenous , Analgesia , Analgesia, Epidural , Analgesia, Patient-Controlled , Analgesics , Anesthesia, Epidural , Injections, Epidural , Laparoscopes , Laparoscopy , Methods , Morphine , Nefopam , Oxycodone , Pain Measurement , Pain, Postoperative , Passive Cutaneous Anaphylaxis , Patient Satisfaction , Pica , Prostatectomy , Thoracic VertebraeABSTRACT
BACKGROUND: The thoracic transforaminal epidural block (TTFEB) is usually performed to treat herpes zoster or postherpetic neuralgia (PHN). Especially, multiple segmental involvements and approximate contrast medium spread range, according to volume, help to choose the proper drug volume in the transforaminal epidural block. This study investigated the contrast medium spread patterns of 1-ml to 3-ml TTFEBs. METHODS: A total of 26 patients with herpes zoster or PHN were enrolled in this study. All participants received 1 ml, 2 ml, or 3 ml of contrast medium. Results were divided into Groups A, B and C based on the volume (1, 2, or 3 ml), with n = 26 for each group. After the injection of contrast medium, the spread levels were estimated in both the lateral and anteroposterior (AP) images using fluoroscopy. RESULTS: The cephalad spread of contrast medium in the lateral image as expressed by the median (interquartile range) was 2.00 levels (1.00–2.00) for Group A, 2.50 (2.00–3.00) for Group B, and 3.00 (2.00-4.00) for Group C. The caudal spread level of contrast medium was 1.00 (1.00-2.00) for Group A, 2.00 (2.00–3.00) for Group B, and 2.00 (2.00–3.00) for Group C. There was ventral and dorsal spread of the 3-ml contrast medium injection in 88% (23/26) of cases in the lateral image. CONCLUSIONS: Injection of 3 ml of contrast medium through the foramina spread 6 levels in a cephalocaudal direction. Spread patterns revealed a cephalad preference. TTFEB resulted in dorsal and ventral spread in a high percentage of cases. This procedure may be useful for transferring drugs to the dorsal and ventral roots.
Subject(s)
Humans , Contrast Media , Fluoroscopy , Herpes Zoster , Injections, Epidural , Nerve Block , Neuralgia, Postherpetic , Spinal Nerve Roots , SpineABSTRACT
@#Transient paralysis occasionally occurs after an epidural injection, but the reasons for this are still unknown. We present here a patient with transient paralysis following loculation of the injectant associated with the procedure. A 50-year-old woman with a history of two previous spinal operations complained of a burning sensation and radiating pain. A caudal block and right S1 transforaminal epidural block were performed. Loculation of the block injectant into the right L5 and S1 epidural space was confirmed through computed topographic imaging. She showed transient weakness of the right lower limb, which completely recovered after 1 day. This case shows that extra care should be taken when performing an epidural injection in a patient with adhesions around the injection site and appropriate adjustments should be made to the volume of the injectant.
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Objective To investigate the clinical effect of intravenous infusion of dextral metomidine and the analgesia of epidural injection.MethodsAccording to the different ways of labor analgesia will be selected in January 2015 to January 2017 in our hospital childbirth puerpera 120 cases are grouped into: the control group with regular continuous epidural analgesia injection way, observation group with intravenous infusion set beauty holds the mi + right regularity discontinuous epidural analgesic injection mode;Record two groups of patients with various experiment data, and will make an analysis of data obtained, conclusion intravenous infusion set right beauty holds the mi joint regularity the clinical effect of continuous epidural labor analgesia injection.ResultsIntravenous right beauty holds the mi + regularity discontinuous epidural injection way for puerpera childbirth analgesia effect is superior to the pure regularity discontinuous epidural injection way analgesia effect, compare the difference between groups was statistically significant (P<0.05).Conclusionpregnant women choosing to analgesia vein infusion set beauty holds the mi + right regularity discontinuous epidural analgesic injection way, clinical analgesic effect is good, will not cause great influence to own and maternal newborn, worth clinical widely used for childbirth analgesia.
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A 77-year-old woman presented with bilateral leg weakness, accompanied by severe axial back and radicular pain, after a L4–5 epidural injection. She had been receiving misappropriated epidural injections for the last few months. A contrast-enhanced magnetic resonance image showed rim enhancing, spinal canal compromising cystic lesion at the posterior epidural space of L4–5. During surgery, a severely central compromised non-communicating cystic lesion located at posterior epidural space was resected. A histological report of this lesion confirmed a pseudocyst containing a degenerated synovial tissue. Herein, we report our experience of cauda equine syndrome after epidural injection with successful treatment.
Subject(s)
Aged , Female , Humans , Cauda Equina , Epidural Space , Injections, Epidural , Leg , Polyradiculopathy , Spinal CanalABSTRACT
<p><b>OBJECTIVE</b>To assess the effect of percutaneous endoscopic lumbar discectomy (PELD) combined with epidural injection for prolapsed lumbar disc herniation(PLDH).</p><p><b>METHODS</b>In this prospective randomized controlled study, the clinical data of 126 patients who had undergone a PELD because of a single-level PLDH from March 2014 to June 2015 were analyzed. There were 67 males and 59 females, ranging in age from 17 to 75 years old with an average of(41.0±13.5) years old, 9 cases were L₃,₄, 76 cases were L₄,₅ and 41 cases were L₅S₁. According to the random number table, the patients were randomized into two groups, with 63 patients in each group. Patients in group 1 were injected normal saline after PLED, patients in group 2 were subjected to an epidural injection of Diprospan, Lidocaine and Mecobalamine after PLED. All the patients were followed up from 6 to 20 months with the mean of 12.4 months. Complications, the postoperative hospital stay, the period of return to work, visual analogue scale (VAS) and Japanese Orthopedic Association (JOA) score were compared between two groups, and clinical outcomes were evaluated according to modified MacNab criteria.</p><p><b>RESULTS</b>All the operations were successful, and no complications were found. The mean postoperative hospital stay and the period of return to work in group 1 were (4.61±1.25) days and (4.31±0.47) weeks, respectively, and in group 2 were (2.53±0.69) days and (3.14±0.52) weeks, there was significant differences between two groups(=0.000). Postoperative VAS and JOA scores in two groups were obviously improved (=0.000). At 1 day, 1 week, 1 month after operation, VAS, JOA scores in group 2 were better than that of group 1(=0.000), and after 6 months, there was no significant difference between two groups(>0.05). According to the modified MacNab criteria, 39 cases got excellent results, 21 good, 3 fair in group 1, and which in group 2 were 41, 20, 2, respectively, there was no significant difference between two groups(=0.087).</p><p><b>CONCLUSIONS</b>PELD is an mini-invasive technique for PLDH, it can fleetly reduce pain and improve function. And combination with epidural injection has the advantages of pain releasing and function improving in the short-term postoperative period, and it can decrease postoperative hospital stay and time of returning to work, and it is a safe and effective method.</p>
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BACKGROUND: Magnetic resonance imaging (MRI) of the spine is the preferred diagnostic tool for pathologic conditions affecting the spine. However, in patients receiving epidural corticosteroid injection (ESI) for treatment of spinal diseases, there is a possibility of misreading of MR images because of air or fluid in the epidural space after the injection. Therefore, we defined the characteristics of abnormal changes in MRI findings following an ESI in patients with low back pain. METHODS: We reviewed the medical records of 133 patients who underwent MRI of the lumbar spine within 7 days after ESI between 2006 and 2015.All patients were administered an ESI using a 22-gauge Tuohy needle at the lumbar spine through the interlaminar approach. The epidural space was identified by the loss of resistance technique with air. RESULTS: The incidences of abnormal changes in MRI findings because of ESI were 54%, 31%, and 25% in patients who underwent MRI at approximately 24 h, and 2 and 3 days after ESI, respectively. Abnormal MRI findings included epidural air or fluid, needle tracks, and soft tissue changes. Epidural air, the most frequent abnormal finding (82%), was observed in 41% of patients who underwent MRI within 3 days after injection. Abnormal findings due to an ESI were not observed in MR images acquired 4 days after ESI or later. CONCLUSIONS: Pain physicians should consider the possibility of abnormal findings in MR images acquired after epidural injection using the interlaminar approach and the loss of resistance technique with air at the lumbar spine.
Subject(s)
Humans , Artifacts , Epidural Space , Glucocorticoids , Incidence , Injections, Epidural , Low Back Pain , Magnetic Resonance Imaging , Medical Records , Needles , Spinal Diseases , SpineABSTRACT
OBJECTIVE: This study was performed to evaluate and compare the efficacies of caudal epidural injections performed at prone and lateral decubitus positions. METHODS: A total of 120 patients suffering from low back pain and radicular leg pain were included and patients were randomly distributed into 2 groups according to the position during injection. In Group 1 (n=60; 32 women, 28 men), caudal epidural injection was performed at prone position, whereas it was implemented at lateral decubitus position in Group 2 (n=60; 33 women, 27 men). Visual analogue scale, Oswestry Disability Index (ODI), walking tolerance (WT) and standing tolerance (ST) were compared in 2 groups before and after injection. RESULTS: In Group 1, ODI values were higher at 30th minute (p=0.007), 3rd week (p=0.043) and 6th month (p=0.013). In Group 1, ODI, VAS and ST values were improved significantly at all follow-up periods compared to initial values. In Group 1, WT scores were better than initial values at 30th minute, 3rd week and 3rd month. In Group 2, ODI scores at 30th minute, 3rd week, 3rd month and 6th month were improved while VAS and ST scores were improved at all periods after injection. WT scores were better at 30th minute, 3rd week and 3rd month compared to initial WT scores. CONCLUSION: Our results indicated that application of injection procedure at lateral decubitus position allowing a more concentrated local distribution may provide better relief of pain.
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Female , Humans , Follow-Up Studies , Hernia , Injections, Epidural , Leg , Low Back Pain , Prone Position , Spinal Stenosis , WalkingABSTRACT
Epidural steroid injection (ESI), which is commonly used for treatment of low back pain with lumbosacral radicular pain, can be performed via transforaminal, interlaminar, or caudal routes. The transforaminal route is generally regarded as more effective than the interlaminar route due to its high level of drug delivery to the ventral epidural space. However, in some postoperative patients, use of the transforaminal route may be difficult. Thus, there is an urgent need for technology that can offer more effective drug delivery to the ventral epidural space with fewer complications. In this context, we describe a case about our new method where patient has undergone oblique interlaminar lumbar epidural steroid injection (OIL-ESI) instead of transforaminal ESI. We treated a patient with OIL-ESI instead of transforaminal ESI. Patient was symptomatic improved at postoperative visits. Based on our findings, OIL-ESI may be a suitable alternative to transforaminal ESI.
Subject(s)
Humans , Epidural Space , Fluoroscopy , Injections, Epidural , Low Back Pain , Methods , Pain ManagementABSTRACT
Epidural steroid injection (ESI), which is commonly used for treatment of low back pain with lumbosacral radicular pain, can be performed via transforaminal, interlaminar, or caudal routes. The transforaminal route is generally regarded as more effective than the interlaminar route due to its high level of drug delivery to the ventral epidural space. However, in some postoperative patients, use of the transforaminal route may be difficult. Thus, there is an urgent need for technology that can offer more effective drug delivery to the ventral epidural space with fewer complications. In this context, we describe a case about our new method where patient has undergone oblique interlaminar lumbar epidural steroid injection (OIL-ESI) instead of transforaminal ESI. We treated a patient with OIL-ESI instead of transforaminal ESI. Patient was symptomatic improved at postoperative visits. Based on our findings, OIL-ESI may be a suitable alternative to transforaminal ESI.
Subject(s)
Humans , Epidural Space , Fluoroscopy , Injections, Epidural , Low Back Pain , Methods , Pain ManagementABSTRACT
Spinal infection due to Serratia marcescens is very rare. A 78-year-old male patient withoutany risk factor was admitted to our hospital with chief complaints of severe back pain, fever, weakness in both legs, and bowel dysfunction, following caudal epidural injection. Magnetic resonance imaging revealed spondylodiscitis with epidural abscess. Surgical decompression was performed and the epidural abscess was removed. The cultures isolated S. marcescens, which can cause nosocomial infection in immunocompromised patient. However, to the best of our knowledge, we report the first case of S. marcescens spinal epidural abscess following epidural injection, with literature review.