Editor-in-Chief: Alaa Abd-Elsayed, MD, PhD

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  1. PMCR-2020;4;135-140 Interventional Spine Considerations for Radiosensitivity in a Patient with Ligase IV Syndrome
    Case Report
    David J. Kohns, DO, and Mahmood Gharib, MD.

BACKGROUND: Patient selection plays a critical role in any interventional pain practice. Rare conditions may not always have clearly established guidelines for interventional pain procedures. Ligase IV (LIG4) syndrome is a rare inherited condition with a wide variety of features, including radiosensitivity..  

CASE REPORT: A 36-year-old woman with a known history of LIG4 syndrome presented with an acute on chronic left L5 and S1 radiculopathy from a large L5-S1 central disc herniation. In an effort to minimize radiation exposure, an ultrasound (US)-guided caudal epidural steroid injection was used to help manage her radicular leg pain.

CONCLUSION: Interventional spine providers should be aware of rare radiosensitive conditions and strive to offer appropriate treatment alternatives. While limitations do exist, emerging US-guide spine procedures hold a distinct advantage for patients with radiosensitivities.

KEY WORDS: Epidural steroid injection, Ligase IV syndrome, radiculopathy, radiology, radiosensitivity, ultrasound