{"id":"c5458a5b-670d-42ca-83d8-37d031137b8a","slug":"should-routine-mri-of-the-lumbar-spine-be-required-prior-to-lumbar-epidural-steroid-injection-for-sciatica-pain","title":"Should routine MRI of the lumbar spine be required prior to lumbar epidural steroid injection for sciatica pain?","authors":["Ramis F. Ghaly","Alexei Lissounov","Kenneth D. Candido","Nebojsa Nick Knezevic"],"abstract":"Background: We describe three patients who received lumbar epidural steroid injections (LESI) for lumbosacral radicular pain that resulted in worsening of their symptoms. The procedures were performed following a review of remote diagnostic imaging studies. These cases demonstrate the lack of consensus in pain management domains for how to approach the workup and treatment of persistent/chronic low back pain, with a noted fragmentation in pain management strategies and applied therapies. Case Description: We present three patients; two female patients (37 and 38 years old) undergoing LESI for remotely diagnosed disc herniations, and one 61-year-old male receiving an LESI for a presumed, unverified lumbar intervertebral disc disorder. Following a worsening of symptoms after LESI, neurosurgical consultations ultimately determined the presence of, respectively, an epidural hematoma, a neurilemoma, and a lung cancer metastasis to the sacrum as the source of symptoms, instead of being due to the intervertebral disc pathology. Conclusions: We would like to emphasize several principles in the diagnosis and use of imaging of the lumbosacral region prior to undertaking invasive neuraxial procedures.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/c5458a5b-670d-42ca-83d8-37d031137b8a/featured/hero-1782420952550.png","publishDate":"2015-03-25T00:00:00.000Z","doi":"10.4103/2152-7806.153888","categories":["Original Article"],"fullTextUrl":"https://surgicalneurologyint.com/wp-content/uploads/2015/04/4634/SNI-6-48.pdf"}