Bilateral lumbar transforaminal epidural steroid injection


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Many forms of foraminal narrowing can be treated with our minimally invasive decompression surgery, which removes a small portion of the bone spur or damaged disc that is protruding into the foraminal canal. Some patients may require the entire disc or vertebra to be removed, however, if the spine condition is severe. In this case, a minimally invasive stabilization surgery would be performed to remove the damaged portion of the spine and then stabilize the spine with an artificial disc or a bone graft made from the patient’s own body.

() A 32-year-old man underwent a lumbar microdiskectomy and an incidental dural tear occurred. A hemilaminectomy was performed to obtain adequate visualization of the defect, and primary repair of the tear was performed. One month postoperatively he returns to the office complaining of severe headaches and occasional nausea which is worse with standing. He denies fever or chills. On physical exam his wound is well healed with no cellulitis or erythema. WBC and ESR are within normal limits. What is the most likely diagnosis? Review Topic

The follow-up of the patients produced contradictory results, which indicated that bilateral cingulotomy is not the optimal treatment for OCD. [17] Of the 44 patients, only 32% both fit the "responder" criteria and showed significant improvement compared to the other subjects. Another 14% exhibited some signs of improvement. Multiple cingulotomies correlated with a higher likelihood of continuing to respond to follow-up inquiries (6% more often fit the full "responder" criteria, 11% more often fit the partial "responder" criteria. However, the side effects associated with the procedure were numerous. Among the complaints that patients had after the surgery were apathy and deficits in memory, although these were rarely reported. In addition, some subjects complained of some form of urinary disturbance, ranging from urinary retention to incontinence . Hydrocephalus (2%) and seizures (2%) were also observed. [17]

The diagnosis was never conclusive to me, since there was no verified bilateral nerve compression, although it is possible that some of the cauda equina is affected by a large central herniation at L5/S1. Now, I feel that my later discovered cervical herniations are more probable as the source of most of my suffering, at least structurally. One intervertebral bulge, in particular, really displaces the spinal cord severely and this may explain the incredible diversity of symptoms I endure. I place far more credence in this theory than in the lumbar disc-enactment suspicions.

Bilateral lumbar transforaminal epidural steroid injection

bilateral lumbar transforaminal epidural steroid injection

The follow-up of the patients produced contradictory results, which indicated that bilateral cingulotomy is not the optimal treatment for OCD. [17] Of the 44 patients, only 32% both fit the "responder" criteria and showed significant improvement compared to the other subjects. Another 14% exhibited some signs of improvement. Multiple cingulotomies correlated with a higher likelihood of continuing to respond to follow-up inquiries (6% more often fit the full "responder" criteria, 11% more often fit the partial "responder" criteria. However, the side effects associated with the procedure were numerous. Among the complaints that patients had after the surgery were apathy and deficits in memory, although these were rarely reported. In addition, some subjects complained of some form of urinary disturbance, ranging from urinary retention to incontinence . Hydrocephalus (2%) and seizures (2%) were also observed. [17]

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