Adhesive arachnoiditis following lumbar epidural steroid injections: a report of two cases and review of the literature

Abstract

Elon Eisenberg,1,2 Rephael Goldman,3 Dorit Schlag-Eisenberg,4 Anat Grinfeld5 1Pain Research Unit, Institute of Pain Medicine, Rambam Health Care Campus, Haifa, Israel; 2B. Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel; 3Amitim Clinic, Haifa, Israel; 4Department of Medical Imaging, Carmel Medical Center, Haifa, Israel; 5Department of Medical Imaging, Rambam Health Care Campus, Haifa, Israel Abstract: 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. Keywords: sciatica, spinal stenosis, magnetic resonance imaging, MRI, radicular pain

Keywords

• Epidural steroid injection
• Arachnoiditis
• Magnetic resonance imaging (MRI)
• Radicular pain