title: Relationship between ventral lumbar disc protrusion and contrast medium leakage during sympathetic nerve block.
abstract: Ventral disc protrusions have been neglected because they are asymptomatic. Lumbar sympathetic nerve block (LSNB) is one of the clinical choices for refractory low back pain treatment. Leakage of the contrast medium may occur and lead to complications, especially when using a neurolytic agent. In this study, we retrospectively reviewed the magnetic resonance images (MRIs) of 52 consecutive patients with refractory low back pain due to lumbar spinal canal stenosis who underwent LSNB, and graded ventral disc protrusion at the L1/2 to L5/S1 vertebral discs on a three-point scale (grade 0 = no protrusion, grade 1 = protrusion without migration, grade 2 = protrusion with migration). We also determined if there was leakage of contrast medium in LSNB. Ventral disc protrusion was observed in all patients, and 75 % (39/52) had grade 2 protrusion in the L1/2-L3/4 vertebral discs. Moreover, the incidence of contrast medium leakage was significantly higher at the vertebrae that had grade 2 protrusion than at those with less protrusion. We revealed a higher incidence of ventral disc protrusion of the lumbar vertebrae than previously reported, and that the incidence of leakage in LSNB increased when ventral disc protrusion was present. To avoid complications, attention should be paid to ventral disc protrusions before performing LSNB.
authors: Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
authors: Toshiharu
authors: T
authors: Tazawa
authors: Yoshinori
authors: Y
authors: Kamiya
authors: Mina
authors: M
authors: Takamori
authors: Ken-Ichi
authors: K
authors: Ogawa
authors: Takahisa
authors: T
authors: Goto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001340:Autonomic Nerve Block / Q000009:adverse effects / Q000379:methods*; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging* / Q000453:epidemiology; D017116:Low Back Pain / Q000628:therapy; D008161:Lumbosacral Region; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011859:Radiography; D013130:Spinal Stenosis / Q000150:complications