• Ramis F Ghaly, Alexei Lissounov, Kenneth D Candido, and Nebojsa Nick Knezevic.
• Ghaly Neurosurgical Associates, Aurora, IL, USA ; Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA ; Department of Anesthesiology, University of Illinois, Chicago, IL, USA.
• Surg Neurol Int. 2015 Jan 1; 6: 48.

BackgroundWe describe three patients who received lumbar epidural steroid injections (LESI) for lumbosacral radicular pain that resulted in worsening of their symptoms. The procedures were performed following a review of remote diagnostic imaging studies. These cases demonstrate the lack of consensus in pain management domains for how to approach the workup and treatment of persistent/chronic low back pain, with a noted fragmentation in pain management strategies and applied therapies.Case DescriptionWe present three patients; two female patients (37 and 38 years old) undergoing LESI for remotely diagnosed disc herniations, and one 61-year-old male receiving an LESI for a presumed, unverified lumbar intervertebral disc disorder. Following a worsening of symptoms after LESI, neurosurgical consultations ultimately determined the presence of, respectively, an epidural hematoma, a neurilemoma, and a lung cancer metastasis to the sacrum as the source of symptoms, instead of being due to the intervertebral disc pathology.ConclusionsWe would like to emphasize several principles in the diagnosis and use of imaging of the lumbosacral region prior to undertaking invasive neuraxial procedures.

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