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

SELECTIVE spinal injection procedures have become an integral part of the interdisciplinary treatment of patients with lumbar disc disease. These procedures can be powerful therapeutic tools in controlling pain and allowing early protected mobilization. Injection of the epidural space, spinal nerves, facet joints, and intervertebral discs cannot be performed safely and reliably without radiographic assistance. Epidural steroids have been used for many years to manage low back pain and sciatica but are still controversial. 1-3 The anesthesiologist is totally dependent on the epidural anatomy and resistance to spread medication around or up to the front of the dural sac. In patients with lumbar disc herniations and radiculopathy, the target site is the interface between the posterior annulus of the intervertebral disc and the ventral dural sac or root sleeve. The commonly used transforaminal injection technique, as described in several reports, improves the delivery of a high concentration of medication to the ventral epidural space. 4-7 Here, we describe a case of a transforaminal sleeve infiltration of the L3 nerve root. After positioning the needle, 2 ml dye was injected, and a discogram was visualized. In a MEDLINE search, we found no previous publications describing this inadvertent event. Possible implications for the interpretation of this observation in daily practice are discussed.