Arachnoiditis Following Caudal Epidural Injections for the Lumbo-Sacral Radicular Pain

Nanjayan, Shashi Kumar; Swamy, Girish; Yallappa, Sachin; Bommireddy, R

doi:10.4184/asj.2013.7.4.355

Cited by 15 publications

(13 citation statements)

References 8 publications

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“…25 Other uncommon but significant adverse effects reported in the literature include adhesive arachnoiditis, perineal pruritus, insomnia, hiccups, flushing, increased radicular pain, epidural abscess, cervical myelomeningitis, and infection. [9][10][11][12]14,15,19,23,25,27,30,35 Steroid injection is a known risk factor for local and/ or distant infection. The increased risk of infection can be attributed to exogenous material introduction through the skin into the spinal epidural space, skin flora, contaminated injection material, 34 and immunosuppressive effects of steroid agents.…”

Section: Discussionmentioning

confidence: 99%

The impact of preoperative epidural injections on postoperative infection in lumbar fusion surgery

Singla

Yang

Werner

et al. 2017

Journal of Neurosurgery: Spine

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OBJECTIVELumbar epidural steroid injections (LESIs) are performed for both diagnostic and therapeutic purposes for a variety of indications, including low-back pain, the leading cause of disability and expense due to work-related conditions in the US. The steroid agent used in epidural injections is reported to relieve nerve root inflammation, local ischemia, and resultant pain, but the injection may also have an adverse impact on spinal surgery performed thereafter. In particular, the possibility that preoperative epidural injections may increase the risk of surgical site infection after lumbar spinal fusion has been reported but has not been studied in detail. The goal of the present study was to use a large national insurance database to analyze the association of preoperative LESIs with surgical site infection after lumbar spinal fusion.METHODSA nationwide insurance database of patient records was used for this retrospective analysis. Current Procedural Terminology codes were used to query the database for patients who had undergone LESI and 1- or 2-level lumbar posterior spinal fusion procedures. The rate of postoperative infection after 1- or 2-level posterior spinal fusion was analyzed. These study patients were then divided into 3 separate cohorts: 1) lumbar spinal fusion performed within 1 month after LESI, 2) fusion performed between 1 and 3 months after LESI, and 3) fusion performed between 3 and 6 months after LESI. The study patients were compared with a control cohort of patients who underwent lumbar fusion without previous LESI.RESULTSThe overall 3-month infection rate after lumbar spinal fusion procedure was 1.6% (1411 of 88,540 patients). The infection risk increased in patients who received LESI within 1 month (OR 2.6, p < 0.0001) or 1–3 months (OR 1.4, p = 0.0002) prior to surgery compared with controls. The infection risk was not significantly different from controls in patients who underwent lumbar fusion more than 3 months after LESI.CONCLUSIONSLumbar spinal fusion performed within 3 months after LESI may be associated with an increased rate of postoperative infection. This association was not found when lumbar fusion was performed more than 3 months after LESI.

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Section: Discussionmentioning

confidence: 99%

The impact of preoperative epidural injections on postoperative infection in lumbar fusion surgery

Singla

Yang

Werner

et al. 2017

Journal of Neurosurgery: Spine

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“…Arachnoiditis. Both epidural and caudal approaches were associated with a limited number of cases of arachnoiditis Subdural injection .…”

Section: Complications After Epidural Corticosteroids: Overviewmentioning

confidence: 99%

Safe Use of Epidural Corticosteroid Injections: Recommendations of the WIP Benelux Work Group

et al. 2018

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“…Complications, such as transient paraplegia10 and arachnoiditis,11 have been reported after CEI, but we could not find any case reports on severe persistent CES after CEI. Here, we report the case of a patient with spinal stenosis suffering severe persistent CES after CEI.…”

Section: Introductionmentioning

confidence: 72%

Persistent cauda equina syndrome after caudal epidural injection under severe spinal stenosis: a case report

Seo¹,

Kong²,

Lee³

et al. 2017

JPR

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Caudal epidural injection (CEI) is one of the most common treatments for low-back pain with sciatica. CEI rarely leads to neurologic complications. We report a case of persistent cauda equina syndrome after CEI. A 44-year-old male patient with severe L4 and L5 spinal ste-nosis underwent CEI for low-back pain and sciatica. The CEI solution consisted of bupivacaine, hyaluronidase, triamcinolone acetonide, and normal saline. He experienced motor weakness and sensory loss in both lower extremities and neurogenic bladder for more than 1 year after the procedure. His ankle dorsiflexors, big-toe extensors, and ankle plantar flexors on both sides were checked and categorized as motor-power Medical Research Council grade 0. His bilateral ankle-jerk reflection was absent. An electrophysiological study showed lumbosacral polyradiculopathy affecting both sides of the L5 and S1 nerve roots. A urodynamic study revealed hypoactive neurogenic bladder affecting both sacral roots.

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Arachnoiditis Following Caudal Epidural Injections for the Lumbo-Sacral Radicular Pain

Cited by 15 publications

References 8 publications

The impact of preoperative epidural injections on postoperative infection in lumbar fusion surgery

The impact of preoperative epidural injections on postoperative infection in lumbar fusion surgery

Safe Use of Epidural Corticosteroid Injections: Recommendations of the WIP Benelux Work Group

Persistent cauda equina syndrome after caudal epidural injection under severe spinal stenosis: a case report

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