Epidural needle fragment related low back pain. Case report

• Autor(a) principal: de-Matos,Daniela
• Data de Publicação: 2021
• Outros Autores: Cabral,Henrique, Pereira,Ricardo
• Tipo de documento: Relatório
• Idioma: eng
• Título da fonte: BrJP (Online)
• Texto Completo: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S2595-31922021000100087
• topic: Chronic pain; Foreign bodies; Needles; Low back pain

ABSTRACT BACKGROUND AND OBJECTIVES: Facet syndrome has increasingly been recognized as one the most common causes of chronic low back pain, despite the significant diagnostic challenges imposed by its protean manifestations. Lumbar zygapophyseal degenerative changes are considered the main etiologic agent in cases of facet-associated lumbar pain, with iatrogenic causes rarely involved, particularly those related to retained foreign bodies following invasive medical or surgical procedures. Only three similar reported cases were found in the literature. CASE REPORT: Female patient, 36 years old, presented significant chronic low back pain due to a Tuohy needle fragment retained in upper part of left L1-L2 facet joint and adjacent tract of the medial branch of the dorsal nerve corresponding to the suprajacent level, following epidural anesthesia performed for elective cesarean section. Failure of conservative treatment and pain intensity led to invasive treatment, with surgical removal of the needle fragment as a stand-alone procedure. Clinical response was favorable, and no additional procedures were necessary thus far. Possible difficulties in diagnosing facet syndrome and the surgical strategy for such an uncommon case are discussed. CONCLUSION: In the case of a rare etiology of low back pain, a particularly accurate clinical and imaging correlation is important to achieve an adequate therapeutic plan. Such plan must encompass an optimal knowledge of spine anatomy and lumbar pain-related mechanisms. Foreign elements that could be responsible for mechanical injury or local inflammatory phenomena contributing to chronic pain should be considered for removal as part of the treatment strategy