Analysis of Inadvertent Intradiscal Injections during Lumbar Transforaminal Epidural Injection

BACKGROUND: Recently, there have been several case reports and retrospective studies about the incidence of intradiscal (ID) injection during transforaminal epidural steroid injection (TFESI). Inadvertent ID injection is not a rare complication, and it carries the risk of developing diskitis, although there has been no report of diskitis after TFESI. We prospectively evaluated the incidence of inadvertent ID injection during lumbar TFESI and analyzed the contributing factors. METHODS: Ten patients received 2-level TFESI, and the remaining 229 patients received 1-level TFESI. When successful TFESI was performed, 2 ml of contrast dye was injected under real-time fluoroscopy to check for any inadvertent ID spread. A musculoskeletal radiologist analyzed all magnetic resonance images (MRIs) of patients who demonstrated inadvertent ID injection. When reviewing MRIs, the intervertebral foramen level where ID injection occurred was carefully examined, and any anatomical structure which narrowing the foramen was identified. RESULTS: Among the 249 TFESI, we identified 6 ID injections; thus, there was an incidence of 2.4%. Four patients had isthmic spondylolisthesis, and the level of spondylolisthesis coincided with the level of ID injection. We further examined the right or left foramen of the spondylolisthesis level and identified the upward migrated disc material that was narrowing the foramen. CONCLUSIONS: Inadvertent ID injection during TFESI is not infrequent, and pain physicians must pay close attention to the type and location of disc herniation.

Availability of Intradiscal Injection of Marcaine as a Pain Relief Test for Diagnosis of Internal Disc Disruption / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To investigate the availability of an intradiscal injection of marcaine as a pain relief test to enhance specificity in the diagnosis of IDD. SUMMARY OF LITERATURE REVIEW: The diagnosis and treatment of IDD have been controversial. A discography, which has been widely used for the diagnosis of IDD, has many problems that might result in a faulty diagnosis. MATERIALS AND METHODS: Twenty nine patients, with an average age and duration of symptom of 36.9 years (22 to 46 years) and 5 years 1 month (6 months to 10 years), respectively, were reviewed. After the discography, the marcaine was injected. Based on the responses after the injection, the group was sub-divided into a further two groups. Group A (n=19): transient pain relief and surgical treatment was performed. Group B (n=10): no pain relief and conservative treatment was performed. An analysis to examine the correlation between the response to marcaine and age, duration of symptom, subjective pain level, number of disc degeneration and high intensity zone was also performed, and the clinical results quantified. RESULTS: The agreement rate between the discography and response to marcaine was 55.2%. The longer the symptom duration, the more meaningful were the responses to the marcaine injection (p<0.05). The result of surgical treatment was important statistically, as the pain was relieved from 8.6 +/- 0.97 to 1.8 +/- 0.42 points, and the ODI decreased from 68 +/- 16.92 to 30 +/- 9.97% (p<0.05). CONCLUSIONS: An intradiscal injection of marcaine, as the pain relief test, can enhance the specificity for the diagnosis of IDD.

Effects of Intradiscal Steroid Injection in Patients with Lumbar Discogenic Pain

OBJECTIVE: To determine the therapeutic effects of intradiscal steroid injection in patients with lumbar discogenic pain. METHOD: Seventeen patients with lumbar discogenic pain who have not received other interventional procedures were studied. After confirmation of needle placement into the discs by C-arm fluoroscopy, discogram was done. And 40 mg of triamcinolone and 0.5 cc of 2% lidocaine were injected into the nucleus. Correlation between degeneration and Visual Analogue Scale (VAS) was analyzed. The effects of steroid injection were evaluated using VAS and limitation of lumbar flexion at pre-injection, 1 week post-injection, 1 month post-injection, and 3 months post-injection. Changes over time were assessed statistically using ANOVA and chi-square. RESULT: Correlation between degeneration and VAS was high (r=0.7). The averages of VAS reduced significantly from 6.1+/-1.6 at pre-injection, to 2.4+/-1.8 at 1 week post- injection, to 1.8+/-1.2 at 3 months post-injection, respectively (p<0.05). The number of group of highly or moderately limited lumbar flexion was decreased from 10 at pre- injection to 4 at 1 day post-injection. Fourteen of 17 patients (82.4%) had a successful outcome reporting at least 50% reduction between pre and 3 months post-injection in VAS. CONCLUSION: Intradiscal steroid injection was an effective treatment for patients with lumbar discogenic pain.