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Matthew J. Kraeutler, Joseph D. Bozzay, Matthew P. Walker and Kuruvilla John

S pinal subdural abscess (SSA), also called a spinal subdural empyema, is extremely rare, with fewer than 100 cases reported. 5 The low incidence of subdural empyema raises the importance of recognizing the characteristic signs and symptoms of these infections. To our knowledge, we report the second published case of a patient presenting with a spinal subdural empyema following a spinal epidural steroid injection. Case Report History and Presentation A 58-year-old Caucasian man returned early from an overseas trip, complaining of increasing low

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Risheng Xu, Mohamad Bydon, Ziya L. Gokaslan, Jean-Paul Wolinsky, Timothy F. Witham and Ali Bydon

E pidural steroid injections are commonly used to temporarily alleviate chronic back pain. 10 , 11 , 25 Although their ability to afford long-term sustainable back pain relief has yet to be conclusively demonstrated, 2 , 15 they are nevertheless widely considered to be associated with few complications and are capable of producing short-term pain alleviation that originates from the lumbar or cervical spine. Despite its acceptance as a relatively safe procedure, however, an epidural steroid injection is not without risk. Minor complications may range

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T. Adam Oliver, Michael Sorensen and Adam S. Arthur

S pinal dural arteriovenous fistulas are the most common type of spinal arteriovenous malformations. Type 1 spinal arteriovenous malformations are defined by the presence of radiculomeningeal feeders that drain into intradural veins. 1 , 6 , 7 , 9 , 12 , 13 Patients with these lesions frequently present with chronic myelopathy, which is most often caused by venous hypertension. There has been a report of acute paraparesis after treatment with epidural steroid injections in patients with SDAVF. 5 We present a case of acute paraparesis following a lumbar

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Peter C. Gerszten, Matthew Smuck, James P. Rathmell, Thomas T. Simopoulos, Sarjoo M. Bhagia, Christopher K. Mocek, Tami Crabtree and Daniel A. Bloch

apart). One week prior to the second TFESI, patients were contacted and reminded of the appointment. In the event that the subject wished to decline the second TFESI, the second injection was cancelled after approval of the investigator. Patients were not blinded to treatment since one treatment group was to receive only one procedure and the other group up to 2 procedures; informed consent required that each procedure be described to the subject in detail. Interventions Transforaminal Epidural Steroid Injection Procedure The TFESI procedure was performed

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Lee A. Tan, Manish K. Kasliwal and Harel Deutsch

TO THE EDITOR: We read with great interest the recently published article by Kraeutler et al. 4 (Kraeutler MJ, Bozzay JD, Walker MP, et al: Spinal subdural abscess following epidural steroid injection. J Neurosurg Spine 22: 90–93, January 2015). The authors presented a case of spinal subdural empyema, which is a rare but serious complication associated with epidural steroid injections (ESIs). We commend the authors' early recognition and prompt treatment of this serious and potentially devastating complication, which led to significant improvement in the

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Nico Sollmann, Dominik Weidlich, Barbara Cervantes, Elisabeth Klupp, Carl Ganter, Hendrik Kooijman, Claus Zimmer, Ernst J. Rummeny, Bernhard Meyer, Thomas Baum, Jan S. Kirschke and Dimitrios C. Karampinos

not clearly associated with one nerve root only, selective segmental nerve blocks by epidural steroid injections (ESIs) and local anesthetics may be helpful in detecting and treating the particular site most probably causing LRS. 40 , 42 Regarding imaging, MRI is often preferred over CT because of the absence of radiation exposure and a better visualization of soft tissues, thus enhancing the visual detection of herniated discs. 26 , 40 However, it is well known that imaging findings do not necessarily correlate with clinical symptoms. In previous investigations

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William C. Watters III, Daniel K. Resnick, Jason C. Eck, Zoher Ghogawala, Praveen V. Mummaneni, Andrew T. Dailey, Tanvir F. Choudhri, Alok Sharan, Michael W. Groff, Jeffrey C. Wang, Sanjay S. Dhall and Michael G. Kaiser

Therapeutic Recommendations There is no new evidence that conflicts with the previous recommendations regarding injection therapies published in the original version of the “Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine.” 27 Lumbar Epidural Steroid Injections Grade C Lumbar epidural steroid injections (ESIs) are an option for the short-term relief of chronic low-back pain without radiculopathy in patients with degenerative disease of the lumbar spine (Level III evidence). Caudal ESIs are an

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Anuj Singla, Scott Yang, Brian C. Werner, Jourdan M. Cancienne, Ali Nourbakhsh, Adam L. Shimer, Hamid Hassanzadeh and Francis H. Shen

epidural steroid injections (LESIs) are the most common nonsurgical interventions performed for the management of lumbar stenosis or radiculopathy; 26 they are performed for both diagnostic and therapeutic purposes. Rates of transforaminal LESIs have increased 665% since 2000, with more than 2.2 million procedures performed each year in the Medicare population. 21 Nerve root inflammation, local ischemia, and resultant pain are reported to be reduced by the potent antiinflammatory effects of glucocorticoids. 1 , 13 , 22 , 34 These injections provide an excellent

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Ricky Medel, Nader Pouratian and W. Jeffrey Elias

numbness in her legs bilaterally. After failing to attain adequate pain control with increasing doses of pain medication(3745 μg/day of fentanyl [4000 μg/ml], 37.45 mg/day of bupivacaine [40 mg/ml], and 2809 mg/day of clonidine[3000 μg/ml]), an epidural steroid injection was performed in the lower cervical region. The unsuccessful injection prompted her pain management physician to order an MR imaging study of her cervical spine, which demonstrated an “epidural hematoma” at C7–T1 with resultant spinal cord compression. She was subsequently transferred to the

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Julio D. Montejo, Joaquin Q. Camara-Quintana, Daniel Duran, Jeannine M. Rockefeller, Sierra B. Conine, Alyssa M. Blaise, Kristopher T. Kahle and Michael L. DiLuna

antiinflammatory drugs, opioid pain medication, physical therapy, chiropractor therapy, epidural steroid injection, as well as the number of emergency department visits due to low-back pain and radicular pain prior to surgical intervention. Variables at presentation included duration of symptoms prior to surgery, presence of radicular low-back pain or leg pain, and bladder or bowel dysfunction. Variables at physical examination included positive straight leg raise, myotomal lower-extremity weakness, and dermatomal sensory loss. All patients underwent diagnostic preoperative MRI