An unusual obstacle to the thoracic interlaminar epidural injection for the treatment of post-herpetic neuralgia

Serhad Bilim, Savaş Şencan, Osman Hakan Gündüz

Division of Pain Medicine, Department of Physical Medicine and Rehabilitation, Marmara University Faculty of Medicine, İstanbul, Türkiye

Keywords: Diffuse idiopathic skeletal hyperostosis, epidural injection, pathologic calcification, postherpetic neuralgia, thoracic spondylosis, thoracic vertebrae.

Abstract

Interlaminar epidural steroid injections corresponding to dermatomes affected by post-herpetic neuralgia (PHN) were found effective in reducing pain. Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory condition that mainly occurs with calcification and ossification of spinal ligaments such as anterior and posterior longitudinal, interspinous, supraspinous ligament, and ligamentum flavum. In this case, it is presented that the failure of the access to the T7-T8 interlaminar space due to the supra/interspinous ligament calcification and ossification accompanied by thoracic DISH in a 73-year-old male for the treatment of PHN.