Inadvertent discogram during epidural steroid injection: a case report

Area of Science:

• Pain Medicine
• Interventional Radiology

Background:

• The necessity of fluoroscopic guidance for epidural steroid injections remains a topic of debate in pain management.
• Studies indicate a significant rate of inaccurate epidural needle placement, up to 35%, when fluoroscopy is not utilized.

Observation:

• This case study details an instance where the loss-of-resistance technique, commonly used for epidural placement, resulted in an inadvertent discogram.
• The procedure involved epidural steroid administration, where needle placement accuracy is critical.

Findings:

• The loss-of-resistance technique, without fluoroscopic confirmation, led to an unintended introduction of contrast into the intervertebral disc.
• This suggests potential risks associated with non-fluoroscopic epidural procedures.

Implications:

• The findings challenge the assumption that the loss-of-resistance technique alone is sufficient for accurate epidural needle placement.
• Further research is warranted to evaluate the safety and efficacy of non-fluoroscopic techniques for epidural steroid injections.
• Clinicians should consider the potential for complications like inadvertent discography when opting against fluoroscopic guidance.