Analysis of Subdural Injection During Lumbar Interlaminar Epidural Injection in Failed Back Surgery Syndrome.

Jin Young Lee,Ji Yeong Kim,Hue Jung Park,Seunghee Cho,Woo Seog Sim,Yu Ri Ko,Mihyeon Lee,So Young Lee

doi:10.3390/jcm9103132

Abstract

Persistent or recurrent back and leg pain following spinal surgery, known as failed back surgery syndrome (FBSS), significantly limits daily life activities. A lumbar epidural injection can reduce adhesions, inflammation, and nerve compression, although the epidural space can be distorted due to dura mater and epidural tissues changes after spinal surgery. This study analyzed subdural injection during lumbar epidural injection in FBSS patients. We retrospectively analyzed data from 155 patients who received a lumbar interlaminar epidural injection to manage FBSS. We grouped the patients based on the injected contrast medium appearance in the subdural (group S) or epidural spaces (group E) in fluoroscopic contrast images. Demographic, clinical, surgical and fluoroscopic data were recorded and evaluated, as were the pain scores before and after injection. There were 59 patients (38.1%) in the subdural group. Injection distance from the surgery level differed between the groups. Risk of subdural injection at level 1 distance from the surgery level had an odds ratio of 0.374, and at level ≥2, it was 0.172, when compared to level 0. Subdural incidence differed with the distance from surgical site. Physicians should strive to reduce subdural incidence when the injection is planned at surgery site in FBSS.

Highlights

Persistent and recurrent back and leg pain following spinal surgery significantly limits everyday life activities [1]
We retrospectively reviewed the electronic medical records of 157 patients with lower back and leg pain in Failed back surgery syndrome (FBSS), who underwent lumbar interlaminar epidural injection between July 2019 and March 2020 at two tertiary care hospitals
Of the 157 patients deemed eligible, two patients for whom the injection was at level 1 were excluded because the failed epidural injection was associated with epidural venogram during epidural approach, at which point the procedure was halted with no complications

Summary

Introduction

Persistent and recurrent back and leg pain following spinal surgery significantly limits everyday life activities [1]. The lumbar epidural space can become distorted due to spinal surgery-associated dura mater and epidural tissue changes [9,10,11]. A subdural space can be formed by the junctions between the neurothelial cells breaking due to mechanical pressure, air, or injected fluid, creating fissures within the interface [12]. These fissures grow larger towards weaker areas, producing an incomplete form, or creating an actual subdural space [12]. If the subdural space forms after surgery, incidence of injections into subdural space may increase, even when using a routine, standardized epidural injection technique.

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