A blunt needle (Epimed®) does not eliminate the risk of vascular penetration during transforaminal epidural injection
A 59-year-old female presented with chronic lumbar radiculopathy attributed to L5-S1 foraminal stenosis documented by magnetic resonance imaging (MRI) []. She underwent a TFESI at the L5-S1 level. Negative aspiration was confirmed, and a 0.5 ml of 1% lidocaine was administered as a test dose; there were no neurological changes. Next, a 22-gauge blunt curved Epimed® needle was slowly advanced into the foramen. Despite negative aspiration, the spread of contrast under live fluoroscopy was clearly consistent with an intravascular injection []. The needle was, therefore, slightly withdrawn and repositioned until contrast spread along the nerve root and epidural canal (epidurogram). There was neither vascular uptake nor intrathecal spread, and aspiration revealed neither blood nor cerebrospinal fluid []. Next, 80 mg of methylprednisolone acetate with 3 ml of lidocaine 0.5% was injected, and the needle was removed with a flash of 1% lidocaine. She tolerated the procedure well without apparent complications.