Injeção subaracnóidea inadvertida de corticóide em tratamento de dor crônica da coluna lombar: relato de caso

Vanni, Simone

doi:10.1590/s0034-70942004000600012

Cited by 4 publications

(2 citation statements)

References 10 publications

(22 reference statements)

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“…[ 7 ] Lastly, unintended subarachnoid injection of local anesthetics and steroids have long been reported to have numerous adverse effects such as spinal block and other motor/sensory neurological deficits, seizures, as well as cardiovascular concerns including cardiac arrest. [ 8 , 9 ] In this case, performing ESI using the interlaminar approach theoretically could have reduced the risk of CSF leakage and other complications, while delivering the medications to the area of pathology.…”

Section: Discussionmentioning

confidence: 99%

Management of lumbar radiculopathy due to disc herniation with interlaminar epidural steroid injection in the presence of multilevel Tarlov cysts in the neural foramina

Güngör

Özcan

2018

Medicine

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Rationale:Perineural cysts, commonly referred to as Tarlov cysts, are cerebrospinal fluid-filled dilations between the perineurium and endoneurium typically arising at the junction of posterior and dorsal root ganglia in the neural foramina. This anatomical location is in close proximity to usual needle trajectory during performing transforaminal epidural injection, and therefore presents a potential risk of dural puncture and associated complications.Patient concerns:Severe lower extremity pain interfering with activities of daily living.Diagnoses:Lumbar radiculopathy secondary to left-sided L4-5 disc herniation in the presence of multilevel Tarlov cysts in the neural foramina.Interventions:Posterior interlaminar epidural steroid injection technique was preferred, as opposed to transforaminal approach, to avoid potential risk of dural puncture and associated complications in the presence of multilevel Tarlov cysts in the neural foramina.Outcomes:The patient responded favorably to epidural steroid injection via interlaminar approach with complete resolution of pain, symptoms, and signs. There were no complications. The patient was able to tolerate physical therapy, wean pain medications, and achieve normal activities of daily living without any significant limitations.Lessons:In patients presenting with an MRI report of “Tarlov cysts”, meticulous evaluation of diagnostic images should be an essential first step before considering invasive spinal procedures. Should there be any presence of Tarlov cyst in close proximity to planned needle trajectory, we recommend appropriate modification of spinal intervention to avoid potential complications.

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Section: Discussionmentioning

confidence: 99%

Management of lumbar radiculopathy due to disc herniation with interlaminar epidural steroid injection in the presence of multilevel Tarlov cysts in the neural foramina

Güngör

Özcan

2018

Medicine

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“…The pathophysiology of sciatica is characterized by the fact that the nucleus pulposus, which causes inflammation, causes the involvement of key inflammatory mediators and leads to demyelination, root ganglion ischemia, and increased endoneural pressure, with consequent reduction of nerve stimulus speed. 24 This inflammatory reaction is followed by the immune response.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of epidural blockade as therapy for patients with sciatica secondary to lumbar disc herniation

Nunes

Pontes

Costa

2016

Revista Brasileira de Ortopedia (English Edition)

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ObjectiveSciatic pain secondary to lumbar disc herniation is a complex condition that is often highly limiting. The causes of pain in disc herniation are multifactorial. Two physiopathological mechanisms are involved in discogenic pain: mechanical deformation of nerve roots and a biochemical inflammatory component resulting from contact between the intervertebral disc and neural tissue, by way of the nucleus pulposus. The aim of this study was to evaluate the efficacy and safety of epidural blockade as therapy for bulging lumbar disc herniation.MethodsA clinical study was conducted based on a retrospective and prospective survey. The blockade consisted of interlaminar puncture and bolus drug delivery. The number of procedures varied according to the clinical response, as determined through weekly evaluations and then 30, 90, and 180 days after the final session. A total of 124 patients who received one to five blockades were evaluated.ResultsThe success rate (defining success as a reduction in sciatic pain of at least 80%) was 75.8%.ConclusionThe results demonstrated the therapeutic action of epidural blockade over the short term, i.e. in cases of acute pain, thus showing that intense and excruciating sciatic pain can be relieved through this technique. Because of the multifactorial genesis of sciatica and the difficulties encountered by healthcare professionals in treating this condition, epidural blockade can become part of therapeutic arsenal available. This procedure is situated between conservative treatment with an eminently clinical focus and surgical approaches.

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Avaliação do bloqueio epidural como terapêutica em pacientes com ciatalgia secundária a herniação discal lombar

Nunes

Pontes

Costa

2016

Revista Brasileira de Ortopedia

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Injeção subaracnóidea inadvertida de corticóide em tratamento de dor crônica da coluna lombar: relato de caso

Abstract: JUSTIFICATIVA E OBJETIVOS:

Cited by 4 publications

References 10 publications

Management of lumbar radiculopathy due to disc herniation with interlaminar epidural steroid injection in the presence of multilevel Tarlov cysts in the neural foramina

Management of lumbar radiculopathy due to disc herniation with interlaminar epidural steroid injection in the presence of multilevel Tarlov cysts in the neural foramina

Evaluation of epidural blockade as therapy for patients with sciatica secondary to lumbar disc herniation

Avaliação do bloqueio epidural como terapêutica em pacientes com ciatalgia secundária a herniação discal lombar

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