Inadvertent Intradiscal Injection with TFESI Utilizing Kambin's Retrodiscal Approach in the Treatment of Acute Lumbar Radiculopathy

Introduction There is very strong evidence for the efficacy of transforaminal epidural steroid injection (TFESI) in relieving lumbar radicular pain due to a herniated disk. However, case studies have documented paralysis as a potential complication from this approach as the artery of Adamkiewicz may traverse within the subpedicular “safe triangle.” Kambin's retrodiscal approach has been postulated as a safe means to the transforaminal approach to avoid the artery of Adamkiewicz. Case Presentation A 51-year-old woman presented with right-sided lumbar radicular pain at the L3–L4 and L4–L5 level secondary to a herniated disk. As conservative therapies failed to improve her radicular back pain, the patient opted to proceed with an epidural steroid injection. She subsequently underwent a right L3–L4 and L4–L5 transforaminal epidural steroid injection via Kambin's retrodiscal approach. Although anteroposterior and lateral views revealed optimal needle placement, live and postcontrast fluoroscopy revealed an unavoidable and inadvertent intradiscal spread. Conclusion Kambin's approach is at the level of the intervertebral disk and may increase the incidence of intradiscal needle entry and injection.