Injections Post Osteomyelitis/Discitis

[paingate21]

has anyone performed epidurals for patients with radicular pain from stenosis/disc herniation or facet blocks for axial back pain in individuals with prior spinal infection? I have not done so - but in a majority of these cases do not have other options.

Curious to hear how others approach.

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[cowboydoc]

has anyone performed epidurals for patients with radicular pain from stenosis/disc herniation or facet blocks for axial back pain in individuals with prior spinal infection? I have not done so - but in a majority of these cases do not have other options.

Curious to hear how others approach.

Facet intervention, sure. Coordinate with ID to CYA, but not a significant issue if remote treatment and recently updated imaging. I’d try hard to avoid the epidural space in this population, but interested to hear the opinions of others…

 

[MitchLevi]

Done it plenty of times. No issues.

 

[nvrsumr]

No thank you. Plenty other spines to poke.

 

[gaspasser127]

I have not. However, i would consider the following:

- how long ago was the infection
- what was the context of that infection and do those factors still exist (IVDU, immunocompromised)
- how was it treated/was it successfully treated
- what level was the infection compared to where you plan on injecting
- the specific injection you’re considering MBB vs ESI etc etc
- how recent is updated imaging?
- any concerning labs at this time?

If you document these things and the risk benefit discussion with the patient i bet you’ll be pretty protected.

 

[Ducttape]

Overall, the short term benefit of a procedure that does carry risk of recurrence - even if low - is not a treatment that I would offer. ESI are elective procedures.

Facet injections ie MBB are not truly spinal so no issues as long as no recent active infection.

 

[SSdoc33]

i would, but the patient would really need the ESI and id document everything. ive done it before

 

[pmrmd]

I have as well, but it was long after the treatment course and ID was satisfied there were no lingering issues. I think there’s a difference using dex versus depo here.

 

[SSdoc33]

I have as well, but it was long after the treatment course and ID was satisfied there were no lingering issues. I think there’s a difference using dex versus depo here.

?

as in dex is safer?

 

[stsa84]

I've done it 3-4 times, semi-grudgingly. Pathology matched well with symptoms. Prior infx not due to IVDU. Got "clearance" from ID to move forward with ESI, documented risk discussion, procedures done without issue.

 

[Bostonspine]

Did diagnostic MBB and RFA for axial lower back pain probably would have been more squeamish with an ESI

 

[Dawkter]

ID will usually give you "clearance" for remote infections but the risk/reward profile is questionable for these cases.

 

[SpineandWine]

I’ve done it
Get ID doc involved
No prophy abx

 

[pmrmd]

?

as in dex is safer?

Absolutely. Dex is gone in 25 hours. The effect doesn’t linger as far as I can tell. That steroid acetate?

 

[plasma.]

Would you guys offer injections q3-4 months in this patient population if they were finding benefit? I have done one or two when really pressed but advise them that it's not something I will continue to offer on an ongoing basis.

 

[gaspasser127]

Would you guys offer injections q3-4 months in this patient population if they were finding benefit? I have done one or two when really pressed but advise them that it's not something I will continue to offer on an ongoing basis.

I would but always document risk and make sure it’s for a true radiculopathy

 

[mygalperin]

has anyone performed epidurals for patients with radicular pain from stenosis/disc herniation or facet blocks for axial back pain in individuals with prior spinal infection? I have not done so - but in a majority of these cases do not have other options.

Curious to hear how others approach.

If the infection resolved in the past not a problem at all, get an MRI to see stir images prior