A rare case of paraplegia complicating a lumbar epidural infiltration

Abstract

Despite the rarity of this complication, patients should be made aware of its potential occurrence. In the case reported here, the functional prognosis is uncertain.

Particulate versus non-particulate steroids for lumbar transforaminal or interlaminar epidural steroid injections: an update

“…Death as well as infarction of cerebellum, brain stem, thalamus, cervical, and lumbar spinal cord have been reported after cervical and lumbar epidural injections, either by an interlaminar or transforaminal approach [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. In the literature, all 17 thoracolumbar spinal cord infarctions related to lumbosacral epidural steroid injection were associated with particulate steroids whereas no case of paraplegia was described after image-guided epidural injection of dexamethasone [16][17][18][19][20][21][22][23][24][25][26].…”

“…In the literature, all 17 thoracolumbar spinal cord infarctions related to lumbosacral epidural steroid injection were associated with particulate steroids whereas no case of paraplegia was described after image-guided epidural injection of dexamethasone [16][17][18][19][20][21][22][23][24][25][26]. It has to be noted that the damage to the spinal cord commonly occurred several segments cranial to the lumbosacral injection site: for instance, in the case reported by Chang Chien et al, a transforaminal epidural steroid injection was performed at the level L5-S1, but subsequently spinal cord infarction on MRI was diagnosed between the T6 and the T9-T10 level [25].…”

“…It has to be noted that the damage to the spinal cord commonly occurred several segments cranial to the lumbosacral injection site: for instance, in the case reported by Chang Chien et al, a transforaminal epidural steroid injection was performed at the level L5-S1, but subsequently spinal cord infarction on MRI was diagnosed between the T6 and the T9-T10 level [25]. All except for one [24] thoracolumbosacral spinal injection associated with ischemic complications described above were carried out as image-guided interventions, either by fluoroscopy or CT, and the use of complementary contrast agent application before steroid injection was common. Spinal cord injury occurred in 11 patients after fluoroscopy-guided [16, 18, 20-23, 25, 26] and in four patients after CT-guided lumbar epidural steroid injections [16,19,21].…”

“…Seven of these 14 transforaminal lumbar epidural steroid injection patients underwent previous lumbar spinal surgery. Three patients suffered from spinal cord injury after interlaminar lumbar epidural steroid injections and all of these patients underwent previous laminectomy below the segments of the injection [22,24,26]. There are no case reports or studies available of spinal cord injury associated with interlaminar lumbar epidural steroid injections in patients without previous lumbosacral spine surgery.…”

“…The following corticosteroids were associated with ischemic stroke of the spinal cord or the posterior cerebral circulation after epidural spinal injections: triamcinolone acetonide, betamethasone, methylprednisolone acetate, and prednisolone acetate [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. No patient in the literature suffered from an ischemic event after cervical or lumbosacral epidural imageguided injection of dexamethasone [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26].…”