Unilateral Diagnostic Infiltration of Lumbar L3 Nerve Root Resulting in an Inadvertent Discogram: The Importance of Fluoroscopic Guidance in Interventional Pain Therapy

Intradiscal Injections Following Transforaminal Block-Etiology and Evidence for Withholding Prophylactic Antibiotics

“…Results of previously reported inadvertent intradiscal injections clearly showed that this complication occurs more frequently in patients with frank disc herniations [5–9]. In those reports, disc herniations were present at the target level in five of six patients [5–9], which confirms previous clinical observations [10]. In our study, only two of six patients had frank disc herniations, but the other four had disc protrusions or disc bulges, which might increase the risk of intradiscal injection.…”

“…Huang and Kwa [5] reported that injecting into degenerated discs can cause a false loss of resistance sensation, or may have no change is sensation whatsoever. Results of previously reported inadvertent intradiscal injections clearly showed that this complication occurs more frequently in patients with frank disc herniations [5–9]. In those reports, disc herniations were present at the target level in five of six patients [5–9], which confirms previous clinical observations [10].…”

“…Haspeslagh et al. [7] suggested that although anatomic connections between a nerve root and the disc are not described, it might be one of the possibilities explaining intradiscal contrast spread, because both the disc and nerve root are of mesodermal origin. In our review, three of six patients had undergone previous lumbar spinal surgery raising the possibility that scar tissue may predispose individuals to intradiscal injection.…”

Analysis of Inadvertent Intradiscal and Intravascular Injection During Lumbar Transforaminal Epidural Steroid Injections

“…Data were collected on the patients' age, sex, type of disease, intradiscal dye appearance, presence of vascular spread of contrast on static, real-time fluoroscopic images, blood flashback, and spinal level where TFESI were performed. We hypothesized that the probability of intradiscal and vascular injections of contrast was 2% and 15%, respectively, based on the review of related articles [6][7][8][9][10][11]16,17,[21][22][23] and the results of our preliminary study. On the basis of an α error level of 0.05, a β error level of 0.2, and a 2-sided test, 234 injections were required as a total sample size with an 80% power.…”

“…6 Recently, there have been several case reports [6][7][8][9] and 2 retrospective studies 10,11 regarding the incidence of intradiscal injection during TFESI. These reports 10,11 suggest an incidence of intradiscal injection as low as 0.25% and 0.17%.…”