Oblique interlaminar lumbar epidural steroid injection for management of low back pain with lumbosacral radicular pain - A case report -

Abstract

In this report, we describe our successful experience using oblique interlaminar lumbar epidural steroid injection (OIL-ESI) to treat patient with low back pain and lumbosacral radicular pain, and a literature review. CASE REPoRTAn 82-year-old female patient who had undergone posterior lumbar interbody fusion in the L4-L5-S1 region eighteen 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.

Comparison of the Oblique Interlaminar and Transforaminal Lumbar Epidural Steroid Injections for Treatment of Low Back and Lumbosacral Radicular Pain

“…1 , 15 Effective ventral epidural spreads have been achieved using several OIL approaches prior to our previous case report. 12 There have been several studies on how well the drug is spreading to the ventral epidural space. A study evaluating the contrast flow pattern in the parasagittal interlaminar and TF approaches reported a ventral epidural spread of 100% and 75%, respectively.…”

“…In these cases, caudal or conventional interlaminar approach can be performed; however, the OIL approach may be useful as an alternative method for effective drug delivery into the ventral epidural space. 12 Another advantage of the OIL approach is that the needle is directed towards the most lateral part of the interlaminar opening; in this way, the needle tip meets the most lateral part of the sac, which is usually the nerve root lesion. Thus, the OIL approach would suffice to drive medication ventrally in the epidural space towards the interface of the exiting nerve root and the disc pathology.…”

“… 8 , 9 Based on this approach and with reference to previous studies on various approaches, 10 , 11 we devised a fluoroscopic-guided, alternative, oblique interlaminar (OIL) approach ( Figure 1 ) and applied it to a patient with a difficult TF approach due to the presence of rods, pedicle screws, and bone harvests for posterior lumbar interbody fusion. 12 Since our first case report, we have performed ESIs using the OIL approach instead of the TF approach in patients who visited our clinic with low back and unilateral lumbosacral radicular pain. The OIL approach showed a ventral epidural spread of the contrast and achieved effective pain relief and functional improvement in the management of low back and unilateral lumbosacral radicular pain.…”

Painless cervical motor radiculopathy relieved by cervical epidural steroid injection - A case report -

“…We injected dexamethasone-a drug with an antiinflammatory effect-in the C4-5 epidural space by using interlaminar approach with the needle slightly pointing to the right to improve the patient's symptoms by targeting the neurogenic and non-neurogenic chemical mediators prior to surgical decompression. Epidural steroid injection is an effective treatment method by injecting anti-inflammatory medication into the perineural environment of the affected nerve root [13]. His motor weakness improved dramatically from the day after the epidural injection.…”

Appropriate angle and depth in thoracic transforaminal epidural block in Koreans

“…Epidural block is performed for control of spinal pain. Although STE entails a complicated procedure and involves radiation exposure, STE provides a greater effect on a desired part with a small dose of drug in comparison to the conventional interlaminar approach, because the drug may be injected at the nerve root and the anterior meningeal epidural space associated with a lesion [10,11]. In principle, STE may be performed at the cervical, thoracic, and lumbar vertebrae, Values are presented as mean ± SD or number of patients.…”