Pain Management Case Reports最新文献

{"title":"Diagnosis and Spontaneous Resolution of an Epidural Hematoma in\u0000a Patient Presenting after Cervical Epidural Steroid Injection","authors":"Ivan Urits","doi":"10.36076/pmcr.2018/2/213","DOIUrl":"https://doi.org/10.36076/pmcr.2018/2/213","url":null,"abstract":"While not a cure for the underlying spinal pathology,\u0000cervical epidural steroid injections (CESI)\u0000are an important minimally invasive treatment\u0000for neck pain with radiculopathy. Although CESIs\u0000are considered safe, cervical epidural hematoma\u0000(CEH) is a major complication and has previously\u0000been reported. Patients, who develop CEH, present\u0000with acute neck pain and upper extremity\u0000radiculopathy. A prolonged time to treatment\u0000may lead to worsened neurological outcome.\u0000Diagnostic magnetic resonance imaging and\u0000surgical decompression is the mainstay of treatment.\u0000This report presents a patient with a history\u0000of chronic neck pain and repeat cervical injections,\u0000who presented with increased neck pain\u0000and upper extremity weakness after undergoing\u0000a CESI. Initial radiographic findings were complicated\u0000and inconclusive of a definitive epidural\u0000hematoma. With conservative management, the\u0000patient showed signs of clinical improvement and\u0000ultimately had spontaneous resolution of his CEH.\u0000Though CEH are frequently rapidly progressing\u0000and most often surgically decompressed, some\u0000acutely presenting cases may be approached conservatively.\u0000Though MRI is an important diagnostic\u0000tool for CEH, interpretation of radiographic findings,\u0000following a recent CESI, may be challenging\u0000due to distortion of the epidural space anatomy.\u0000Patients with a history of multiple cervical epidural\u0000injections may have an increased risk for the development\u0000of CEH.\u0000Key words: Cervical epidural steroid injection,\u0000cervical epidural hematoma, spontaneous resolution,\u0000conservative management, magnetic resonance\u0000imaging, complication","PeriodicalId":110696,"journal":{"name":"Pain Management Case Reports","volume":"109 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124572939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inadvertent Spinal Shock during an Intrathecal Drug Delivery System\u0000Refill – A Case Report and Troubleshooting Algorithm","authors":"Gaurav Chauhan","doi":"10.36076/pmcr.2018/2/227","DOIUrl":"https://doi.org/10.36076/pmcr.2018/2/227","url":null,"abstract":"Intrathecal drug delivery systems (IDDS) are\u0000used to treat patients with chronic refractory\u0000pain syndromes and spasticity. IDDS offer an\u0000effective therapy to control pain while offering\u0000the advantage of a decrease in the incidence\u0000of side effects from high-dose systemic opioid\u0000therapy. Serious outcomes including death\u0000or permanent brain damage may occur from\u0000medication administration errors, primarily during\u0000maintenance of IDDS. The pump refill and reprogramming\u0000procedures, although elemental in\u0000theory, are not bereft of serious and fatal side effects\u0000.The importance of understanding the IDDS\u0000and competency in performing pump refills and\u0000programming is of critical importance. To reduce\u0000the risk of drug-related errors, particular attention\u0000should be paid to the proper functioning of pump\u0000hardware, drug reservoir volume discrepancies\u0000and overdose symptoms reported by patients.\u0000Furthermore, the clinician should be prepared for\u0000drug errors and follow the risk mitigation flowchart\u0000mentioned in the clinician refill reference card\u0000provided by the IDDS manufacturer. We present\u0000a case report of a 62-year old male with a history\u0000of post-laminectomy syndrome, associated with\u0000chronic back pain for the last 4 years. The patient\u0000developed inadvertent total spinal shock during a\u0000refill procedure of the IDDS reservoir. The educational\u0000objective of this case report is to highlight\u0000troubleshooting options, plus some of the risks\u0000and complications that can occur when managing\u0000an intrathecal pump delivery system. Clinicians\u0000involved in the ongoing care of patients with IDDS\u0000should undergo periodic competency validations.\u0000Imaging modalities are useful adjuncts for intrathecal\u0000pump refills when a patient has a more difficult\u0000entry or previous complications at the time of refill.\u0000A rapid recognition of evolving complications and\u0000implementation of appropriate treatment are the\u0000cornerstones of successfully managing complications\u0000associated with refilling of IDDS.\u0000Key words: Intrathecal drug delivery system,\u0000drug refill, total spinal shock, seroma, catheter\u0000port study, rotor study","PeriodicalId":110696,"journal":{"name":"Pain Management Case Reports","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127657630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PLATELET-RICH PLASMA INJECTION THERAPY FOR REFRACTORY COCCYDYNIA: A CASE SERIES","authors":"Fergie-Ross L. Montero-Cruz","doi":"10.36076/pmcr.2018/2/183","DOIUrl":"https://doi.org/10.36076/pmcr.2018/2/183","url":null,"abstract":"Background: Coccydynia is pain in the coccyx\u0000region. The most common cause of coccydynia\u0000is trauma, either from a direct axial force such\u0000as during a fall onto the coccyx or from cumulative\u0000trauma as a result of poor sitting mechanics.\u0000Risk factors include obesity, female gender and\u0000rapid weight loss. The anatomy of the region is\u0000not well vascularized, and consists of the coccyx\u0000bones, and supporting ligaments and tendons.\u0000For a majority of patients, conservative management\u0000may be successful but for the remainder\u0000of patients, pain relief may only be transient and\u0000pain can become debilitating. What has yet to be\u0000fully explored is the possible beneficial effect of\u0000local injection of platelet-rich plasma (PRP) for\u0000the treatment of refractory coccydynia. PRP injections\u0000have been successful in treating a variety\u0000of chronic tendon, ligament and bone injuries by\u0000inducing an inflammatory response to promote or\u0000re-initiate healing. In addition, local injections of\u0000PRP to the coccyx would be a less invasive option\u0000than surgery for patients who have exhausted all\u0000other treatment options and continue to struggle\u0000with the debilitating effects of coccydynia.\u0000Objectives: To demonstrate the important role\u0000of PRP therapy in treating coccydynia refractory\u0000to traditional conservative management.\u0000Study Design: Retrospective case series.\u0000Methods: Three patients with coccygeal pain\u0000for greater than 6 months who presented to an\u0000outpatient pain management office in New York\u0000from 2014 until 2016, and failed conventional\u0000treatments. When the pain was deemed refractory\u0000for the patient, offering for PRP was done.\u0000This was presented with the option to repeat once\u0000again at the 6-8 week mark if needed. All patients\u0000underwent PRP with fluoroscopic injection, and\u0000the use of the same PRP commercially available\u0000system; Magellan-Arteriocyte. The patients were\u0000evaluated with a numerical rating scale, and percentage\u0000of pain relief at 6-8 week post-injection, 6\u0000months post-injection, 12 months post-injection,\u0000and 24 months post-injection was recorded.\u0000Percentage of pain relief was then calculated.\u0000Results: Overall the patient series demonstrated\u0000significant improvement in numeric pain scale, as\u0000well as percentage of pain reduction. At the 6-8\u0000week follow-up for all the post-PRP injections,\u0000there was an average of 75% improvement in\u0000overall pain. At 6 months, 1 patient had no change,\u0000while 2 patients maintained the same reduction\u0000in pain at the 12- and 24-month follow-ups.\u0000Limitations: This retrospective case\u0000series is only a small sample size of pat\u0000i e n t s w i t h r e f r a c t o r y c o c c y d y n i a .\u0000Conclusions: Here we discuss the first case\u0000series of PRP for coccydynia. The results of the\u00003 patients in this case series are encouraging.","PeriodicalId":110696,"journal":{"name":"Pain Management Case Reports","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124650995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"WIRELESS HIGH FREQUENCY SPINAL CORD STIMULATION FOR THE TREATMENT OF POST-HERPETIC OCULAR NEURALGIA: A CASE REPORT","authors":"Nick Vanquathem","doi":"10.36076/pmcr.2018/2/167","DOIUrl":"https://doi.org/10.36076/pmcr.2018/2/167","url":null,"abstract":"Background: High frequency wireless Spinal\u0000Cord Stimulation (SCS) at the C1-C2 vertebral\u0000levels provides analgesia for the treatment of\u0000refractory ocular pain on the left side secondary\u0000to post-herpetic neuralgia.\u0000Objective: To assess analgesic effects of minimally\u0000invasive wireless neuromodulation in the\u0000treatment of chronic pain due to post-herpetic\u0000neuralgia.\u0000Study Design: This observational, prospective\u0000case report was designed to illustrate the effectiveness\u0000of relieving chronic, intractable pain\u0000utilizing wireless spinal cord stimulation at multiple\u0000frequencies for the treatment of post-herpetic\u0000neuralgia.\u0000Setting: Private Practice Interventional Pain\u0000Clinic.\u0000Methods: This is a single case study of a 62-yearold\u0000patient who experienced an episode of\u0000shingles with rash over the left frontal and lateral\u0000ocular margin. After the rash subsided, the patient\u0000began suffering from severe pain in the left eye.\u0000The patient was placed on a 10-day course of\u0000valacyclovir, gabapentin, which was discontinued\u0000secondary to sedation intolerance, pregabalin\u0000titrated to 300 mg/day and oxycodone, all of which\u0000were ineffective in relieving the pain. The patient\u0000received a stellate ganglion block injection on 6\u0000occasions, experiencing pain relief of only up to\u0000one-day after each injection. Stellate ganglion\u0000radiofrequency ablation was also unsuccessful.\u0000With original Visual Analog Scale (VAS) score of\u00009/10, inability to sleep and incapacity to perform\u0000activities of daily living (ADLs), the patient had\u0000Stimwave Freedom wireless stimulators placed\u0000sequentially at the C1-C2 vertebral levels.\u0000Results: Programming at low frequencies from\u000040-120 Hz was unsuccessful in reducing left eye\u0000pain. Stimulation was increased to high frequency\u0000on the Stimwave SurgeTM adjustable waveform,\u0000and within 12 hours, the patient noted significant\u0000decrease in pain. At 3 days post-procedure, the\u0000patient’s VAS score was 1/10. The patient had\u0000permanent placement of the devices, and at\u00008-month follow-up, VAS scores were 0-2/10, and\u0000the patient’s mood, sleep and ability to perform\u0000ADLs all improved substantially.\u0000Limitations: The study was limited by the novelty\u0000of the device. Although the doctor who implanted\u0000the device is very experienced, more cases of the\u0000use of the wireless Stimwave Freedom apparatus\u0000are necessary to establish its long-term effectiveness\u0000and safety. More clinical trials investigating\u0000the utilization of multiple frequencies are also\u0000required.\u0000Conclusions: Epidural placement of 2, wireless\u0000sequentially placed octopolar stimulators with a\u0000minimally invasive technique at high frequency\u0000stimulation was safe and effective.\u0000Key words: post-herpetic neuralgia, ocular, spinal\u0000cord stimulation, wireless, shingles, trigeminal\u0000nerve, high frequency","PeriodicalId":110696,"journal":{"name":"Pain Management Case Reports","volume":"59 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130593502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"RADIOFREQUENCY FACILITATED MANUAL SEMI-ENDOSCOPIC DISCECTOMY\u0000UTILIZING THE DISC FX® SYSTEM IN THE TREATMENT OF DISC-PREDOMINATE\u0000LUMBAR SPINAL STENOSIS","authors":"G. Arcos","doi":"10.36076/pmcr.2018/2/173","DOIUrl":"https://doi.org/10.36076/pmcr.2018/2/173","url":null,"abstract":"Background: Lumbar spinal stenosis (LSS)\u0000occurs with increasing prevalence in the elderly\u0000population. The American Academy of Orthopedic\u0000Surgeons has estimated that by 2021,\u00002.4 million adults in the United States (8-11% of\u0000the population) will be affected by this condition.\u0000Surgical options for LSS are being performed\u0000with increased frequency, high cost, and substantial\u0000risk of life-threatening complications.\u0000While nonsurgical treatment options for LSS are\u0000available, they are limited by patient selection\u0000(ligamentum flavum hypertrophy) or high rates\u0000of reoperation (Interspinous process spacer\u0000devices).\u0000This study is the first to suggest a minimally\u0000invasive treatment option for disc-predominate\u0000lumbar central canal stenosis.\u0000Objectives: To evaluate the clinical efficacy of\u0000radiofrequency facilitated manual semi-endoscopic\u0000discectomy utilizing the Disc FX® system\u0000in the treatment of disc-predominate lumbar\u0000spinal stenosis.\u0000Study Design: Single center, prospective, observational\u0000study.\u0000Setting: Multi-specialty private practice clinic.\u0000The Medical Group of South Florida, Jupiter, FL.\u0000Methods: This study involved 6 patients with\u0000disc-predominant lumbar central spinal stenosis.\u0000All patients were treated with the Disc FX®\u0000system. Radiographic evidence of central lumbar\u0000stenosis was confirmed by measurement of minimum\u0000AP canal diameter (mm) performed by 1\u0000board-certified neuroradiologist. Inclusion criteria\u0000included absence of lumbar surgery, physical\u0000therapy within the previous 6 months, failure of\u0000epidural steroid injections (3) within the previous\u00008 months, spondylolisthesis limited to Grade I,\u0000disc height > 50%, presence of low back axial\u0000pain + leg pain exacerbated by walking, and\u0000relieved with sitting or forward flexion, absence\u0000of dermatomal radicular leg pain, radiographic\u0000evidence of disc displacement > 4 mm from disc\u0000endplate. Zurich claudication (symptom severity\u0000and physical function scale was administered 1\u0000week preoperatively, and again 6 months postoperatively.\u0000There were no patients lost to follow up.\u0000Results: All patients in the study demonstrated\u0000moderate-severe or severe central canal stenosis,\u0000with an average AP canal diameter of 6.63\u0000mm for all treated disc levels and 5.5 mm for the\u0000most severe levels. There was a mean improvement\u0000of 57% in a symptom severity scale and\u000056% in the physical function scale at 6 months.\u0000This exceeds the improvement reported with\u0000interspinous spacer devices.\u0000Limitations: Limitations include very small\u0000sample size, observational design, non-randomization,\u0000absence of share controls, short\u0000follow-up period.\u0000Conclusion: For patients suffering from discpredominant\u0000lumbar spinal stenosis, The Disc\u0000FX® System provides an effective, low-cost\u0000alternative to surgical intervention.\u0000Key words: Spinal, stenosis, claudication, disc,\u0000Disc FX®, operative, minimally invasive, Zürich\u0000claudication score","PeriodicalId":110696,"journal":{"name":"Pain Management Case Reports","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124103568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HIGH FREQUENCY 10KHZ SPINAL CORD STIMULATION FOR FAILED NECK\u0000SURGERY SYNDROME: A CASE REPORT","authors":"Andrea Tinnirello","doi":"10.36076/pmcr.2018/2/189","DOIUrl":"https://doi.org/10.36076/pmcr.2018/2/189","url":null,"abstract":"","PeriodicalId":110696,"journal":{"name":"Pain Management Case Reports","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128337772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"USAGE PATTERNS OF SACROILIAC JOINT INJECTIONS - A COMPARATIVE\u0000EVALUATION OF PRE AND POST AFFORDABLE CARE ACT IN MEDICARE\u0000POPULATION","authors":"L. Manchikanti","doi":"10.36076/pmcr.2018/2/157","DOIUrl":"https://doi.org/10.36076/pmcr.2018/2/157","url":null,"abstract":"Background: The sacroiliac joints (SIJ) have\u0000been implicated as highly prevalent, pervasive,\u0000expensive, causes of chronic low back pain. The\u0000utilization of SIJ injections is escalating. A recent\u0000analysis demonstrated a reversal of growth of\u0000utilization patterns of interventional techniques\u0000post passage of the Affordable Care Act (ACA).\u0000Bearing that in mind, SIJ injections along with\u0000facet joint interventions seem to have increased\u0000modestly in that same period.\u0000Study Design: Analysis of growth patterns of SIJ\u0000injections from 2000 to 2016 with comparative\u0000analysis of pre- and post- ACA.\u0000Objectives: To assess utilization patterns of SIJ\u0000injections from 2000 to 2016.\u0000Methods: The Centers for Medicare and Medicaid\u0000Services (CMS) Physician/Supplier Procedure\u0000Summary (PSPS) Master dataset was\u0000utilized in this analysis.\u0000Results: The results of the evaluation from 2000\u0000to 2016 showed, 11.7% increase from 2009 to\u00002016, with an annual increase of 1.6% per 100,000\u0000Medicare population compared to an increase of\u0000299.8% from 2000 to 2009 with annual increase\u0000of 16.6%.\u0000Limitations: The limitations of this study included\u0000a lack of inclusion of Medicare Advantage patients\u0000and the possibility that state claims data may include\u0000claims from other states. As with all claims\u0000based data analyses, this study is retrospective\u0000and thus potentially limited by bias. Finally, patients\u0000who are self or commercially insured are\u0000not part of the dataset.\u0000Conclusions: Study shows dampened increase\u0000in utilization patterns of SIJ injections from 2009\u0000to 2016 as compared with a like time period prior.\u0000Key words: Chronic spinal pain, low back pain,\u0000sacroiliac joint arthritis, interventional techniques,\u0000interventional pain management, sacroiliac joint\u0000injections","PeriodicalId":110696,"journal":{"name":"Pain Management Case Reports","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116529409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A REPORT ON USE OF 10% LIDOCAINE NEUROLYSIS FOR CHRONIC\u0000REFRACTORY SUPRAORBITAL NEURALGIA","authors":"Gaurav Chauhan, Daanish Khaja, Farayi Mbuvah, Aman Upadhyay","doi":"10.36076/pmcr.2018/2/193","DOIUrl":"https://doi.org/10.36076/pmcr.2018/2/193","url":null,"abstract":"We present a case report of a 50-year-old female\u0000with a past medical history of chronic headaches\u0000diagnosed as supraorbital neuralgia. Her\u0000headaches had been refractory to conventional\u0000analgesic medications and she had received\u0000multiple supraorbital nerve blocks which gave\u0000her temporary relief of the headaches lasting up\u0000to 2 weeks. The patient also received chemical\u0000neurolysis of the supraorbital nerve bilaterally\u0000with 10% Lidocaine bilaterally, under fluoroscopic\u0000guidance in the pain clinic. The patient reported\u0000positive outcome following the block with significant\u0000pain control for up to 6-7 months postprocedure.\u0000The authors conclude that in a patient\u0000with a refractory headache due to supraorbital\u0000neuralgia, a 10% lidocaine,injection can be an\u0000efficacious alternative to radiofrequency ablation\u0000as it yields optimum symptom control for up to\u00006 - 7 months and is a relatively easy procedure\u0000to perform. Furthermore, the procedure is not\u0000associated with significant side effects and with\u0000reversibility of induced sensory functional deficits,\u0000offering an advantage over radiofrequency\u0000ablation.\u0000Key words: Lidocaine, supraorbital neuralgia,\u0000neurolysis, nerve blocks, flouroscopy","PeriodicalId":110696,"journal":{"name":"Pain Management Case Reports","volume":"2015 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114447289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DIAGRAMMATIC ANALYSIS OF SUBARACHNOID CONTRAST SPREAD IN THE\u0000CONTRALATERAL OBLIQUE VIEW: A TECHNICAL REPORT","authors":"Ivan Urits","doi":"10.36076/pmcr.2018/2/141","DOIUrl":"https://doi.org/10.36076/pmcr.2018/2/141","url":null,"abstract":"Interlaminar epidural steroid injections are commonly\u0000used in clinical practice for the relief of low\u0000back pain. Reliable deposition of medication\u0000in the epidural space is important in producing\u0000significant results. Pathological conditions,\u0000including vertebral osteoarthritis, degenerative\u0000disc disease, and spinal stenosis, are frequently\u0000treated with epidural steroid injections. Associated\u0000degenerative features such as ligamentum\u0000flavum hypertrophy, facet joint hypertrophy, and\u0000osteophyte formation can lead to significant alterations\u0000in the anatomy of the epidural space.\u0000Epidurograms, prior to steroid injection, aid the\u0000physician in identifying the epidural space, as a\u0000false loss of resistance can occur. Extradural,\u0000subdural, intradural, and subarachnoid contrast\u0000spread has been demonstrated in the anteroposterior\u0000and lateral views; but, has not previously\u0000been demonstrated in the contralateral oblique\u0000(CLO) view. This technical report is the first to\u0000demonstrate concomitant epidural and subarachnoid\u0000spread in the contralateral oblique view after\u0000inadvertent low volume subarachnoid injection,\u0000as might happen in clinical practice.\u0000In this technical report, we demonstrate both\u0000epidural and subarachnoid contrast spread in the\u0000contralateral oblique view and compare it to the\u0000anteroposterior view.\u0000In an oblique view, epidural contrast spread is\u0000observed to approximate the ventral margin of the\u0000superior aspect of the lamina while subarachnoid\u0000contrast spread has a distinct demarcation at the\u0000ventral laminar margin. In an anteroposterior view,\u0000epidural spread is confirmed by spread of the dye\u0000along the nerve roots and beyond the margins of\u0000the pedicles.\u0000The CLO view provides an accurate and consistent\u0000visualization of the epidural space; irrespective\u0000of the obliquity, epidural contrast is observed\u0000to approximate the ventral margin of the superior\u0000aspect of the lamina. In the CLO view, if contrast\u0000spread does not approximate the lamina, then\u0000intrathecal injection must be considered.\u0000Key words: Epidural steroid injection, epidurogram,\u0000epidural spread, subarachnoid injection,\u0000intrathecal spread, fluoroscopy, contralateral\u0000oblique view","PeriodicalId":110696,"journal":{"name":"Pain Management Case Reports","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121801432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Epidural Hematoma Following a Cervical Epidural Injection\u0000in a Patient without Bleeding Risk","authors":"L. Manchikanti","doi":"10.36076/pmcr.2018/2/119","DOIUrl":"https://doi.org/10.36076/pmcr.2018/2/119","url":null,"abstract":"An acute epidural hematoma following a cervical\u0000interlaminar epidural injections is rare, but when\u0000it occurs, it can be associated with devastating\u0000complications if appropriate corrective action is\u0000not taken. Surgical decompression or conservative\u0000management has been proposed in managing\u0000acute epidural hematoma, based on the\u0000progression of symptomatology with neurologic\u0000dysfunction.\u0000We report a case of a cervical epidural hematoma\u0000in a healthy 43-year-old functioning female\u0000patient without overt risk factors for procedural\u0000hemorrhagic complications including baseline\u0000coagulopathy, baseline dysfunction, and intake of\u0000anticoagulants. There were no technical difficulties\u0000in performing the procedure. The patient developed\u0000symptomatology consisting of neck pain,\u0000left upper extremity pain, weakness in the left\u0000lower extremity, and inability to urinate following\u0000the cervical interlaminar epidural. Unbeknownst\u0000to the provider, who had performed the epidural\u0000injection, the patient presented to the local emergency\u0000room and underwent a workup to rule out\u0000cardiac etiologies for her symptoms. The patient\u0000was also given ketorolac intravenously for neck\u0000pain. The provider who performed the epidural\u0000injection was informed 18 hours post-procedure.\u0000The patient had progressive symptomatology with\u0000neurological dysfunction including weakness and\u0000numbness. The provider suspected an epidural\u0000hematoma. As a result, an emergent magnetic\u0000resonance imaging (MRI) was performed, which\u0000showed a significant collection of blood within\u0000the epidural space, which clinically required\u0000surgical decompression. Subsequently, surgical\u0000decompression was carried out with full recovery\u0000of neurologic function.\u0000Issues in managing an acute epidural hematoma\u0000are related to avoidance of drugs increasing\u0000hemorrhagic complications and rapid diagnosis\u0000with appropriate therapy, with shared decision\u0000making. These hematomas can be managed\u0000conservatively or with surgery. Nonsurgical management\u0000is influenced by the initial neurological\u0000presentation and spontaneous recovery or at least\u0000lack of progression of the deficit. After reasonable\u0000monitoring, if stable status is absent and neurological\u0000dysfunction is increasing, then surgical\u0000decompression is recommended.\u0000Key words: Cervical epidural injection, cervical\u0000epidural hematoma, bleeding risk factors, surgical\u0000decompression, nonsurgical management,\u0000ketorolac","PeriodicalId":110696,"journal":{"name":"Pain Management Case Reports","volume":"185 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128693429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}