Can EYİGÖR, Tülin ARICI, Mustafa KURÇALOĞLU, Meltem UYAR

Transforaminal epidural steroid enjeksiyonu ve infranöral yaklaşım

Transforaminal epidural steroid enjeksiyonu radiküler ağrı tedavisi için kullanılan yaygın bir girişimdir. Komplikasyonları nadir fakat katastrofiktir. En nadir katastrofik komplikasyonlarından biri Adamkiewicz arter (AKA) oklüzyonu ile ilgilidir. Bu sunumda transforaminal epidural steroid enjeksiyonu ile ilişkili AKA injurisinden kaçınmak için uyguladığımız yaklaşımı sunduk. 71 yaşında erkek hasta kliniğimize lomber disk hernisine bağlı radikülopati ile başvurdu. Hastaya transforaminal steroid enjeksiyonu planlandı. Radyokontrast enjeksiyonu sonrasında vasküler dolum görüldü. Bunun üzerine iğneye yeniden pozisyon verilerek epidural alana ulaşmak için inferior giriş uygulandı. Vasküler yayılım görülmedi ve dexametazon enjekte edildi. Transforaminal epidural enjeksiyon radiküler ağrı için efektif bir girişimsel ağrı tedavisidir. Fakat muhtemel katastrofik komplikasyonlar nedeniyle dikkatli olmayı gerektirir. AKA büyük oranda foramenin üst yarısında lokalizedir. Spinal kord iskemisini önlemek için AKA’nın çok geniş bir anatomik varyasyona sahip olduğunu akılda bulundurmak çok önemlidir.

Transforaminal epidural steroid injection and infraneural approach

Transforaminal epidural steroid injections are a common intervention in the treatment of radicular pain. Complications are rare,but can be catastrophic. One of the potentially devastating complications is occlusion of the artery of Adamkiewicz (AKA). Thisreport is a description of an approach to avoid the complication of injury to the AKA related to transforaminal epidural injection.A 71-year-old male patient presented at the clinic with radiculopathy secondary to lumbar disc hernia. A transforaminal epiduralsteroid injection was planned. After a radiocontrast injection, vascular filling was detected. The needle was repositioned and aninferior entrance to the epidural space was used. No vascularity was seen and dexamethasone was administered to the patient.A transforaminal epidural steroid injection is an effective interventional treatment for radicular pain, but it requires careful attentiondue to the possible complications. The AKA was located in the upper half of the foramen. Keeping the wide variation in theanatomy of the AKA in mind is very important in order to prevent spinal cord ischemia.

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