This case involves a forty-five-year-old female patient who was undergoing treatment for chronic lower back pain. The patient was referred to a pain management center where an interventional radiologist injected a steroid directly into the patient’s spinal cord. The patient complained of immediate pain after the procedure and she was taken to the emergency room where an MRI was done to confirm the swelling around the cord. The patient now experiences significant discomfort including persistent back pain and trouble ambulating without assistance.
Question(s) For Expert Witness
- 1. What is the standard of care in this procedure?
Expert Witness Response E-004038
Corticosteroids may be administered into the lumbar epidural space through either a caudal or lumbar approach, with the latter approach advocated as more target specific and requiring smaller volumes of injectate. For the same reason, many spine specialists advocate transforaminal steroids because this route of administration is placed more precisely at or near the presumed painful nerve root. Once the drug is injected into the epidural space, the operator has no control over dispersal, which is governed by injection volume and pressure and the anatomy of the epidural space. Normal epidural ligaments or epidural scarring may obstruct passage of injectate to the desired site. To overcome these perceived difficulties, some operators advocate delivering the drugs into the epidural space immediately surrounding the nerve root. Therefore, the target nerve root is approached with the needle under radiographic guidance along an oblique paravertebral approach. Targeting the root, and not the epidural space, is more likely to deliver the corticosteroid solution to the affected nerve root.