SURGICAL-TREATMENT OF THE COMPLICATIONS O F INTRA DISCAL INJECTIONS OF TRIAMCINOLONE HEXACETONIDE - VALUE OF A NEW RADIO-CLINICAL STAGING SYSTEM

Epidural granulomas following intra-discal injection of triamcinolone hexacetonide are a well-known complication of this procedure, which is still encountered, even if its utilization was discontinued several y ears ago. According to the results of their experience, the authors pr opose a new radio-clinical grading system: grade I : disc calcificatio n with aspect of << sub-ligamentar hernia,, on CT scan; grade II : asc endant or descendant retrosomatic migration of discal content; grade I II : pseudotumoral epidural infiltrate producing progressive narrowing of the spinal canal with neurological disturbance. Surgical indicatio ns in these cases can be drawn from their evolution ; posterior approa ch can be used, with or without laminectomy, for excision as complete as possible of the involved disc (grades I and II); anterior approach should be prefered in cases of multiples recurrences after medical tre atment and failure of classical posterior approach, or in case of necr otico-inflammatory proliferation with narrowing of the spinal canal (g rade III).