Every week, we continue to see patients who have had inappropriately performed CT guided spinal injections by radiologists. Here is yet another example of a patient who, according to the radiologist's report, has received an epidural steroid injection via the L5 root hole on the left side for pain caused by a large discus hernia L5/S1 luxated downwards (SIC!!)
The MRI shows a voluminous discus hernia L5/S1, evidently producing a disco-radicular conflict at the level of the S1 root. Did the radiologist make any clinical assessment and neurological examination before attempting his procedure ??
Has the X-ray technician noted the direction towards the L5 root? No, this is the route to the L4 root. The procedure will be done two levels above the affected root level, S1.
Do we see the needle tip? Not certain, but it is clear that it's not in the region of the foramen. Will the injection reach the L4 nerve root? Probably not! Will it reach the area of disco-radicular conflict in the upper sacral anterior epidural space? Certainly not! Will it reach the S1 root which is the appropriate target ? Certainly not!
Here is the proof. The mixture of steroids and contrast dissect backwards along the needle, through the tissues all the way to the subcutaneous area. For the patient, there was no benefit from the treatment. When will radiologists start learning pain medicine and follow the procedure guidelines published by international scientific medical societies like the International Spine Intervention Society (ISIS) and the International Society for the Study of Pain (IASP) ??
I'm interested in your experience and comments!
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