Epidural abscesses following chronic pain injections

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This report will present two cases of epidural abscesses following pain interventions and review available evidence and provide preventive strategies for its avoidance. A 54-year-old man having chronic low back and leg pain with past history significant for alcohol dependence and lumbar spine surgeries received a caudal epidural steroid injection following multiple intravascular injection of contrast. Eleven days following the procedure he developed symptoms suggestive of epidural abscess. It was subsequently confirmed by magnetic resonance imaging (MRI) and underwent nonsurgical management of the abscess without any neurological deficit. A 50-year-old homeless man with history of intravenous drug abuse, alcohol abuse, hepatitis C positive, squamous cell carcinoma of the neck, and degenerative lumbar disc disease received trigger point injections to his lumbar paraspinal muscles for management of his myofascial pain syndrome. Fifteen days following the injection, he reported to the emergency (ER) room with complaints of worsening pain. An MRI revealed epidural; abscesses tracking from the paraspinal muscles. He was subsequently managed with intravenous antibiotics and recovered uneventfully. Following review of the literature, it is possible to come up with preventive strategies to mitigate the occurrence of epidural abscesses. One of the key factors is the presence of comorbid conditions including diabetes mellitus and prior spine surgery which may dictate technique for the management of pain.