[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-497288-105":59,"doc-detail-497288-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","pain-medicine-case-reports-volume-10-issue-4","Pain Medicine Case Reports - Volume 10 - Issue 4","","Low-volume contrast medium spread during a left L4 transforaminal epidural steroid injection is rarely described. This case report presents a 52-year-old woman with left L4 radicular pain who received a stepwise injectate totaling 1 mL of nonionic contrast before therapeutic agents. Despite negative aspiration and minimal volume, contrast showed bilateral periradicular spread and bilateral opacification. Pain improved markedly within one month, and no complications occurred. The findings suggest patient-specific epidural anatomical variations and technical factors may influence contrast distribution.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/pain-medicine-case-reports-volume-10-issue-4/497288/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/pain-medicine-case-reports-volume-10-issue-4/497288.png","ImageObject",300,407,{"name":92,"@type":93},"Terk","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-29","2026-10-02",true,{"@type":102,"interactionType":103,"userInteractionCount":19},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What procedure and injectate volume were used in this case?","Question",{"text":112,"@type":113},"A left L4 transforaminal epidural steroid injection was performed. Nonionic contrast medium was injected in a total of 1 mL (0.5 mL followed by another 0.5 mL), followed by a therapeutic injectate totaling 4 mL.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What unusual imaging finding was observed?",{"text":117,"@type":113},"Although low-volume ipsilateral spread is typically expected, the injected contrast produced early contralateral periradicular spread with bilateral opacification on imaging.",{"name":119,"@type":110,"acceptedAnswer":120},"How did the patient’s pain change after the injection?",{"text":121,"@type":113},"At one month postinjection, pain improved from a Numeric Rating Scale of 8 to 2, with no reported complications.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},497288,1793082878,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":19,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":19,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":52,"preview_page_count":4},1099525198933,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Pain Medicine case RePoRts  \nISSN 2768-5152  \n©2026, American Society of Interventional Pain Physicians© Volume 10, Number 4, pp. 375-378  \nLow VoLume ContraLateraL PeriradiCuLar Contrast medium sPread during a Left L4 transforaminaL ePiduraL injeCtion:  \na Case rePort  \nAtak Karabacak, MD  \n\n| Background: | Contralateral contrast medium spreading at very low volumes during a transforaminal epidural injection is rarely seen. |  |\n| --- | --- | --- |\n| Case Report: | A 52-year-old woman with left L4 radicular pain and an L4–L5 broad-based protrusion underwent a left L4 transforaminal epidural steroid injection. After negative aspiration, injecting 0.5 mL of nonionic contrast medium outlined the left L4 root and crossed the midline; an additional 0.5 mL reproduced bilateral periradicular contrast medium spread. A therapeutic injection (1 mL 0. 5% bupivacaine, 1 mL (40 mg) triamcinolone, and 2 mL saline; 4 mL total injectate) was administered. At one month postinjection, her pain improved from a Numeric Rating Scale score of 8 to 2. There were no complications. |  |\n| Conclusion: | Bilateral opacification observed with only 1 mL may reflect patient-specific anatomical variations, including potential midline ventral epidural fenestrations related to the Hoffmann ligament or peridural membrane variability. |  |\n| Key words: | Transforaminal epidural steroid injection, lumbar radiculopathy, contralateral periradicular spread, Hoffmann ligaments |  |\n| BACKGROUND |  | below approximately 2.5 mL (4), and in a prospective |\n| Lumbar transforaminal epidural steroid injections |  | study using 2 mL of contrast medium, no spread beyond |\n| (TFESI) are commonly performed for radicular pain when |  | the midline to the contralateral foramen was observed; |\n| conservative treatment is insufficient (1) . Before admin- |  | the spread was generally ventral and unilateral (5) . |\n| istering steroids, it is essential to confirm periradicular |  | Against this background, the present case describes |\n| spread and exclude intravascular or intradiscal injection |  | early bilateral perineural spread with a total of 1 mL |\n| by observing contrast medium behavior with fluoros- |  | of contrast medium is instructive from both anatomical |\n| copy (2) . Conventional teaching emphasizes ipsilateral |  | and technical perspectives. |\n| periradicular spread at low test volumes; progression |  | This unusual bilateral spread, occuring with minimal |\n| into the ventral epidural space may be seen as volumes |  | injection volume, challenges the traditional under- |\n| increase (3) . However, contralateral spread with low |  | standing of epidural contrast medium dynamics and |\n| volume from a single ipsilateral needle rarely happens. |  | highlights the complex interaction between anatomical |\n| Previous fluoroscopic studies have described patterns |  | variations in the epidural space and injection pressure. |\n| of contrast medium spread during lumbar TFESI. Con- |  | Furthermore, the observation of this phenomenon at |\n| tralateral crossing has been reported to be uncommon |  | such a low volume suggests that factors other than |\n\nFrom: Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Republic of Turkey  \nCorresponding Author: Atak Karabacak, MD, E-mail: [dr.atakkarabacak@gmail.com](dr.atakkarabacak@gmail.com)  \n[Disclaimer: There was no external funding in the preparation of this manuscript.](Disclaimer: There was no external funding in the preparation of this manuscript.)  \n[Acknowledgement: I thank Sava](Acknowledgement: I thank Sava)ş Şencan, MD for his advice on the preparation of this case report.  \nConflict of interest: Each author certifies that he or she, or a member of his or her immediate family, has no commercial association (i.e. , consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted manuscript.  \nPatient consent for publication: Consent obta","cbCaiqjaDYFprz0L","https://ap.wps.com/l/cbCaiqjaDYFprz0L","pdf",1176353,"English","# Background\n## Case Report\n## Conclusion\n## Case Presentation","[{\"question\":\"What procedure and injectate volume were used in this case?\",\"answer\":\"A left L4 transforaminal epidural steroid injection was performed. Nonionic contrast medium was injected in a total of 1 mL (0.5 mL followed by another 0.5 mL), followed by a therapeutic injectate totaling 4 mL.\"},{\"question\":\"What unusual imaging finding was observed?\",\"answer\":\"Although low-volume ipsilateral spread is typically expected, the injected contrast produced early contralateral periradicular spread with bilateral opacification on imaging.\"},{\"question\":\"How did the patient’s pain change after the injection?\",\"answer\":\"At one month postinjection, pain improved from a Numeric Rating Scale of 8 to 2, with no reported complications.\"}]","Pain Medicine Case Reports - Volume 10 - Issue 4 | PDF",1790951247]