A Rare Calcified Complication of Epidural Injections for Lumbar Spinal Stenosis: A Case Presentation and Literature Review

Pain Medicine Case Reports Pub Date : 2022-11-30 DOI:10.36076/pmcr.2022.6.271

Carl-Elie Majdalani, MD, Christopher Mares, MD, Daniel Shedid, MD, Sung-Joo Yuh, MD

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Abstract

BACKGROUND: Neurogenic claudication secondary to degenerative lumbar stenosis is typically managed with nonsurgical options, such as epidural corticosteroid injections. As a standard and effective treatment for lumbar stenosis, clinicians must be aware of the corticosteroids choice when injecting in the epidural space. CASE REPORT: A 62-year-old man presenting with sciatic pain is treated with multiple neuroforaminal, facet, and caudal corticoid injections over the course of several months without any symptomatic resolution. A magnetic resonance imaging of his lumbar spine revealed focal bilateral central stenosis at the L4-L5 level. A computed tomography revealed hyperdense lesions at that level. The patient was referred for a surgical option. He underwent complete minimally invasive resection of the bilateral lesion with instrumented and interbody fusion. The final pathology report identified the mass as a calcified granuloma. CONCLUSIONS: Following repetitive methylprednisolone acetate injections, one must be aware of all the potential complications arising from particulate corticosteroids. KEY WORDS: Spinal stenosis, epidural injections, granulomas, corticosteroids

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硬膜外注射治疗腰椎管狭窄症的罕见钙化并发症:1例报告及文献复习

背景:退行性腰椎管狭窄继发的神经源性跛行通常采用非手术治疗，如硬膜外皮质类固醇注射。作为腰椎管狭窄的一种标准有效的治疗方法，临床医生在硬膜外腔注射时必须注意皮质类固醇的选择。病例报告:一名62岁男性，以坐骨骨疼痛为表现，在几个月的时间里接受了多次椎间孔、关节面和尾侧皮质激素注射治疗，但没有任何症状缓解。腰椎磁共振成像显示双侧局灶性中枢性狭窄位于L4-L5水平。计算机断层扫描显示该部位有高密度病变。病人被转介接受手术治疗。他接受了双侧病变的全微创切除和内固定和椎间融合。最终病理报告确定肿块为钙化肉芽肿。结论:重复注射醋酸甲泼尼龙后，必须注意颗粒皮质类固醇引起的所有潜在并发症。关键词:椎管狭窄，硬膜外注射，肉芽肿，皮质类固醇

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Pain Medicine Case Reports

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