{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T02:32:15Z","timestamp":1773023535682,"version":"3.50.1"},"reference-count":36,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2013,3,6]],"date-time":"2013-03-06T00:00:00Z","timestamp":1362528000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pain Practice"],"published-print":{"date-parts":[[2014,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Transforaminal epidural steroid injections (<jats:styled-content style=\"fixed-case\">TFESI<\/jats:styled-content>) are commonly performed for the treatment of lumbar herniated nucleus pulposus and lumbosacral radiculopathy. Although rare, documented complications including spinal cord infarction, paraparesis, epidural abscess, paraplegia, and epidural hematoma have been reported. Here, we present a case of perineural hematoma affecting the <jats:styled-content style=\"fixed-case\">L<\/jats:styled-content>4 nerve root resulting in progressive acute\u2010on\u2010chronic lumbar radiculopathy following <jats:styled-content style=\"fixed-case\">TFESI<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case Report<\/jats:title><jats:p>A 72\u2010year\u2010old female presented with 3\u00a0months of low back and right anterior thigh pain. She subsequently underwent right <jats:styled-content style=\"fixed-case\">L<\/jats:styled-content>3 and <jats:styled-content style=\"fixed-case\">L<\/jats:styled-content>4 <jats:styled-content style=\"fixed-case\">TFESI<\/jats:styled-content> for physical examination findings concordant with radiographic right foraminal stenosis at <jats:styled-content style=\"fixed-case\">L<\/jats:styled-content>3\u20104 and <jats:styled-content style=\"fixed-case\">L<\/jats:styled-content>4\u20105 with <jats:styled-content style=\"fixed-case\">L<\/jats:styled-content>3\u20104 spondylolisthesis. Over the following week, the patient reported progressive right lower extremity weakness, worsening sensory loss, and ambulatory dysfunction. Examination revealed mild <jats:styled-content style=\"fixed-case\">L<\/jats:styled-content>3\/4 myotomal weakness, sensory changes, and areflexia at the right patella. A gadolinium\u2010enhanced <jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content> was ordered, which showed focal abnormal signal with involvement of the right <jats:styled-content style=\"fixed-case\">L<\/jats:styled-content>4\u2010<jats:styled-content style=\"fixed-case\">L<\/jats:styled-content>5 neuroforamina and extending slightly far laterally, consistent with a small hematoma, affecting the <jats:styled-content style=\"fixed-case\">L<\/jats:styled-content>4 nerve root. Within 2\u00a0months, her strength and reflexes normalized and sensory loss diminished following medical management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Although extremely rare, perineural or foraminal hematomas may occur as a serious complication of <jats:styled-content style=\"fixed-case\">TFESI<\/jats:styled-content>, even in the setting of a standardized procedure. Hematoma may cause worsening of symptoms in the acute and subacute phase following <jats:styled-content style=\"fixed-case\">TFESI<\/jats:styled-content>. Further investigation into the etiologies of such injuries is warranted and must be added to the considerations of pain physicians performing these procedures.<\/jats:p><\/jats:sec>","DOI":"10.1111\/papr.12047","type":"journal-article","created":{"date-parts":[[2013,3,6]],"date-time":"2013-03-06T14:26:06Z","timestamp":1362579966000},"page":"271-277","source":"Crossref","is-referenced-by-count":23,"title":["Perineural Hematoma Following Lumbar Transforaminal Steroid Injection Causing Acute\u2010on\u2010Chronic Lumbar Radiculopathy: A Case Report"],"prefix":"10.1111","volume":"14","author":[{"given":"Mehul J","family":"Desai","sequence":"first","affiliation":[{"name":"The GW Spine &amp; Pain Center George Washington University Medical Center Washington District of Columbia U.S.A"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shivani","family":"Dua","sequence":"additional","affiliation":[{"name":"The GW Spine &amp; Pain Center George Washington University Medical Center Washington District of Columbia U.S.A"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2013,3,6]]},"reference":[{"key":"e_1_2_4_2_1","first-page":"7","article-title":"Interventional techniques: evidence based practice guidelines in the management of chronic spinal pain","volume":"10","author":"Boswell MV","year":"2007","journal-title":"Pain Physician"},{"key":"e_1_2_4_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200201010-00005"},{"issue":"1","key":"e_1_2_4_4_1","first-page":"S87","article-title":"Lumbosacral epidural steroid injections","volume":"3","author":"Cannon DT","year":"2000","journal-title":"Arch Phys Med Rehabil"},{"key":"e_1_2_4_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199206001-00020"},{"key":"e_1_2_4_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-6576.1990.tb03097.x"},{"key":"e_1_2_4_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(85)90173-3"},{"key":"e_1_2_4_8_1","first-page":"53","article-title":"Chronic lumbosciatic syndrome treated by epidural injection and manipulation","volume":"209","author":"Warr AC","year":"1972","journal-title":"Practitioner"},{"key":"e_1_2_4_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ro.2003.10.010"},{"key":"e_1_2_4_10_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.trap.2009.06.025"},{"key":"e_1_2_4_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4637.2011.01119.x"},{"key":"e_1_2_4_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12178-008-9035-2"},{"key":"e_1_2_4_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0404.1992.tb05487.x"},{"key":"e_1_2_4_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(90)91162-C"},{"key":"e_1_2_4_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-199911000-00065"},{"key":"e_1_2_4_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-198901000-00021"},{"key":"e_1_2_4_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s003300050514"},{"key":"e_1_2_4_18_1","first-page":"253","article-title":"Allergic or pseudoallergic reaction following epidural steroid deposition and skin testing","volume":"14","author":"Simon DL","year":"1989","journal-title":"Reg Anesth"},{"key":"e_1_2_4_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4637.2010.00908.x"},{"key":"e_1_2_4_20_1","doi-asserted-by":"crossref","first-page":"266","DOI":"10.36076\/ppj.2002\/5\/266","article-title":"Effectiveness of transforaminal epidural steroid injections in low back pain: a one\u2010year experience","volume":"5","author":"Rosenberg SK","year":"2002","journal-title":"Pain Physician"},{"key":"e_1_2_4_21_1","doi-asserted-by":"crossref","first-page":"374","DOI":"10.36076\/ppj.2000\/3\/374","article-title":"Transforaminal lumbar epidural steroid injections","volume":"3","author":"Manchikanti L","year":"2000","journal-title":"Pain Physician"},{"key":"e_1_2_4_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200702000-00022"},{"key":"e_1_2_4_23_1","volume-title":"Clinical Anatomy of the Lumbar Spine","author":"Bogduk N","year":"2012"},{"key":"e_1_2_4_24_1","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1988.68.5.0798"},{"key":"e_1_2_4_25_1","doi-asserted-by":"crossref","first-page":"288","DOI":"10.36076\/ppj.2002\/5\/288","article-title":"Vascular supply to the lumbar spine: an intimate look at the lumbosacral nerve roots","volume":"5","author":"Gilchrist RV","year":"2002","journal-title":"Pain Physician"},{"key":"e_1_2_4_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-198507000-00004"},{"key":"e_1_2_4_27_1","first-page":"22","article-title":"Arteries and veins of the lumbar nerve roots and cauda equine","volume":"115","author":"Dommisse GF","year":"1976","journal-title":"Clin Orthop Relat Res"},{"key":"e_1_2_4_28_1","first-page":"829","volume-title":"Textbook of Regional Anesthesia","author":"Jankowski CJ","year":"2002"},{"key":"e_1_2_4_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF03013437"},{"key":"e_1_2_4_30_1","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0b013e3181c15c70"},{"issue":"6","key":"e_1_2_4_31_1","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/S1098-7339(98)90137-7","article-title":"Anticoagulation and neuraxial block: historical perspective, anesthetic implications, and risk management","volume":"23","author":"Horlocker TT","year":"1998","journal-title":"Reg Anesth Pain Med"},{"key":"e_1_2_4_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2003.10.007"},{"key":"e_1_2_4_33_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200010150-00014"},{"key":"e_1_2_4_34_1","doi-asserted-by":"publisher","DOI":"10.1097\/00115550-200807000-00007"},{"key":"e_1_2_4_35_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e31819d0d45"},{"key":"e_1_2_4_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0090-3019(02)00639-0"},{"key":"e_1_2_4_37_1","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1995.83.1.0001"}],"container-title":["Pain Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fpapr.12047","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/papr.12047","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,2]],"date-time":"2023-10-02T06:08:09Z","timestamp":1696226889000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/papr.12047"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,3,6]]},"references-count":36,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2014,3]]}},"alternative-id":["10.1111\/papr.12047"],"URL":"https:\/\/doi.org\/10.1111\/papr.12047","archive":["Portico"],"relation":{},"ISSN":["1530-7085","1533-2500"],"issn-type":[{"value":"1530-7085","type":"print"},{"value":"1533-2500","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,3,6]]}}}