Eisenberg Elon, Goldman Rephael, Schlag-Eisenberg Dorit, Grinfeld Anat
Pain Research Unit, Institute of Pain Medicine, Rambam Health Care Campus, Haifa, Israel,
B. Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel,
J Pain Res. 2019 Jan 29;12:513-518. doi: 10.2147/JPR.S192706. eCollection 2019.
Lumbar epidural steroid injections (LESIs) are commonly used for managing lower back pain (LBP) and radicular pain. LESIs are generally considered safe with only rare serious complication. One very rare complication that is frequently cited in the literature is adhesive arachnoiditis. However, a literature search failed to detect even one published manuscript, clearly documenting LESI induced arachnoiditis. This article presents two patients who received a transforaminal L5-S1 and two L3-L4 interlaminar LESIs. Although the presented patients developed clear radiological (MRI) findings of arachnoiditis, they were not accompanied by any improvement or deterioration in their clinical condition. The article also reviews the literature on the prevalence, pathogenesis, diagnosis, and clinical features of adhesive arachnoiditis. Literature suggests that adhesive arachnoiditis following LESIs is a rare entity, which - as seen in our patients - has clear radiological characteristics but uncertain pathogenesis. It has a large spectrum of clinical presentation, ranging from an incidental finding to a serious neurological sequela. In at least some patients with adhesive arachnoiditis following LESI, the radiological and clinical findings may fail to correlate with each other. In light of the fact that LESI is one of the most commonly performed procedures for managing LBP, clinicians should be aware of this rare yet existing entity.
腰椎硬膜外类固醇注射（LESIs）常用于治疗下背痛（LBP）和神经根性疼痛。LESIs一般被认为是安全的，仅有罕见的严重并发症。文献中经常提到的一种非常罕见的并发症是粘连性蛛网膜炎。然而，一项文献检索甚至未能发现一篇明确记录LESIs诱发蛛网膜炎的已发表手稿。本文介绍了两名接受经椎间孔L5-S1和两次L3-L4椎板间LESIs注射的患者。尽管所介绍的患者出现了明确的蛛网膜炎影像学（MRI）表现，但他们的临床状况并未出现任何改善或恶化。本文还回顾了关于粘连性蛛网膜炎的患病率、发病机制、诊断和临床特征的文献。文献表明，LESIs后发生的粘连性蛛网膜炎是一种罕见的情况，正如我们的患者所见，它具有明确的影像学特征，但发病机制尚不确定。它有广泛的临床表现，从偶然发现到严重的神经后遗症。在至少一些LESIs后发生粘连性蛛网膜炎的患者中，影像学和临床发现可能相互不相关。鉴于LESIs是治疗LBP最常用的手术之一，临床医生应该了解这种罕见但确实存在的情况。
