Case ReportParaplegia following lumbosacral steroid epidural injections☆
Introduction
Transforaminal epidural steroid injections have long been used as conservative treatment of lumbosacral radiculopathy. Known serious complications such as epidural hematoma, abscess, and arachnoiditis are uncommon, with a reported incidence of less than 1%. Spinal cord ischemia is an extremely rare complication, of which both physicians and patients need to be aware.
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Case report
A 46 year old woman with chronic L5 radiculopathy secondary to a herniated disc presented to her physiatrist for a transforaminal L5-S1 steroid epidural injection. The patient was placed in the prone position on a flexed fluoroscopy-compatible operating table. After aseptic preparation and draping, a 20-gauge Tuohy needle was used to administer a preparation of methylprednisolone acetate and bupivacaine with fluoroscopic guidance. Correct placement of the needle was confirmed by
Discussion
Lumbosacral radiculopathy is one of the most common disorders evaluated by neurologists in the outpatient setting. Most cases are transient and managed with symptomatic and conservative treatment. Transforaminal epidural steroid injections may be used in the nonsurgical management of lumbosacral radiculopathy. Although rare, hematoma, abscess formation, arachnoiditis, and meningitis are serious complications of epidural injections. First described in 2001 by Houten and Errico, spinal cord
Conclusion
Spinal cord ischemia is believed to be the cause of the patient’s presentation and MRI findings. An infectious or inflammatory etiology causing transverse myelitis (TM) in our case was less likely, considering that transverse myelitis typically has a subacute onset and affects the cervical or thoracic cord. It would also be an unprecedented coincidence for transverse myelitis to present immediately after a steroid epidural injection. The lack of cerebrospinal leukocytosis also suggests an
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The authors have no disclosures to report.