title: Inadvertent Intradiscal Injection with TFESI Utilizing Kambin's Retrodiscal Approach in the Treatment of Acute Lumbar Radiculopathy.
abstract: BACKGROUND
  There is very strong evidence for the efficacy of transforaminal epidural steroid injection (TFESI) in relieving lumbar radicular pain due to a herniated disk. However, case studies have documented paralysis as a potential complication from this approach as the artery of Adamkiewicz may traverse within the subpedicular "safe triangle." Kambin's retrodiscal approach has been postulated as a safe means to the transforaminal approach to avoid the artery of Adamkiewicz.
  
  
  METHODS
  A 51-year-old woman presented with right-sided lumbar radicular pain at the L3-L4 and L4-L5 level secondary to a herniated disk. As conservative therapies failed to improve her radicular back pain, the patient opted to proceed with an epidural steroid injection. She subsequently underwent a right L3-L4 and L4-L5 transforaminal epidural steroid injection via Kambin's retrodiscal approach. Although anteroposterior and lateral views revealed optimal needle placement, live and postcontrast fluoroscopy revealed an unavoidable and inadvertent intradiscal spread.
  
  
  CONCLUSIONS
  Kambin's approach is at the level of the intervertebral disk and may increase the incidence of intradiscal needle entry and injection.
authors.affiliation: Department of Physical Medicine and Rehabilitation at Hofstra North Shore, LIJ School of Medicine, Manhasset, New York, U.S.A.
authors.forename: Kevin H
authors.initials: KH
authors.lastname: Trinh
authors.affiliation: Departments of Anesthesia and Orthopaedic Surgery, NYU Associates, Franklin Lakes, New Jersey, U.S.A.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Gharibo
authors.affiliation: Department of Physical Medicine and Rehabilitation at Hofstra North Shore, LIJ School of Medicine, Manhasset, New York, U.S.A.|Musculoskeletal Medicine, Manhattan Spine and Pain, New York, New York, U.S.A.
authors.forename: Steve M
authors.initials: SM
authors.lastname: Aydin
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007268:Injections, Epidural / Q000009:adverse effects* / Q000379:methods*; D007403:Intervertebral Disc / Q000187:drug effects*; D007405:Intervertebral Disc Displacement / Q000150:complications; D017116:Low Back Pain / Q000188:drug therapy; D008159:Lumbar Vertebrae; D008875:Middle Aged; D011843:Radiculopathy / Q000188:drug therapy* / Q000209:etiology
chemical_list: D000305:Adrenal Cortex Hormones
keywords: Kambin's retrodiscal approach; back pain with radiation; discitis; inadvertent intradiscal injection