Pain physician
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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.
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Case Reports
Acute renal failure during a trial of spinal cord stimulation: theories as to a possible connection.
This is the first case describing an episode of acute renal failure occurring during a spinal cord stimulation trial. ⋯ The development of the episode of acute renal failure may have been influenced by the secondary effects of spinal cord stimulation. Since acute renal failure has never been associated with the use of spinal cord stimulation, this singular example does not by itself demonstrate a relationship. However, if future episodes are seen, a link between the 2 events could be drawn. For now, it is not clear if the development of this patient's acute renal failure could, in part, be attributed to the use of the spinal cord stimulator or if it was merely coincidental in nature. We do feel it is useful for the clinician to understand the pathophysiologic changes associated with spinal cord stimulation and to see how, at least in theory, there could be a connection.
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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.