Pain physician
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Disc Biacuplasty is a procedure for treating discogenic pain through neuron ablation by heating intervertebral disc tissue using cooled, bipolar radiofrequency (RF) technology. This study demonstrates temperature profiles created by disc biacuplasty in human cadavers. ⋯ The anterior disc and PLL remained at safe temperatures below 45 degrees C while temperatures throughout the center posterior and posterolateral disc were all raised above 45 degrees C, sufficient for neural ablation.
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Subdural migration of epidural catheters is well known and documented. Subdural placement of intrathecal catheters has not been recognized. Two cases of sudural placement of intrathecal catheters are presented. ⋯ These cases differ from others in the literature because the catheter was apparently subdural at the time of initial implantation. As these 2 cases demonstrate, this placement may manifest immediately, but it may remain undetected for a prolonged period. Initial subdural placement should be considered along with catheter migration into the subdural space in the differential of a malfunctioning pump.
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Case Reports
Vertebral osteomyelitis: a potentially catastrophic outcome after lumbar epidural steroid injection.
Epidural steroid injections are commonly used to palliate the symptoms of spinal stenosis. Deep tissue infection is a known potential complication of these injections. There have been no previous published cases of osteomyelitis without epidural abscess after such injections. We present a case in an elderly patient who presented only with persistent axial low back pain following a lumbar epidural steroid injection (LESI). We emphasize early patient evaluation, consideration of infectious predisposing factors, sterile technique, and skin disinfectant. ⋯ This case demonstrates that even with proper aseptic techniques, immune-compromised patients who are colonized with an aggressive micro-organism may develop a potentially catastrophic infectious complication if subtle persistent symptomatic complaints are not promptly and carefully evaluated.