Neurologic complications of lumbar epidural analgesia

Bertol, Vicente; Ara, J.R.; Oliveros, Antonio; Gros, Belén

doi:10.1212/wnl.48.6.1732

Cited by 10 publications

(4 citation statements)

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“…In a few reported cases, the epidural catheter in anesthesia inserted through the hole in the ligamentum flavum, complicating both paraspinal and epidural abscesses 17-20. Intraoperative findings in the reported case showed a significant amount of pus in the epidural space communicated with paraspinal abscess through a hole in the ligamentum flavum, although neither inflammatory tissue nor obvious pus was observed in the L4-L5 facet joints.…”

Section: Discussionmentioning

confidence: 77%

Paraspinal Abscess Communicated with Epidural Abscess after Extra-Articular Facet Joint Injection

et al. 2007

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Facet joint injection is considered to be a safe procedure. There have been some reported cases of facet joint pyogenic infection and also 3 cases of facet joint infection spreading to paraspinal muscle and epidural space due to intra-articular injections. To the author's knowledge, paraspinal and epidural abscesses after facet joint injection without facet joint pyogenic infection have not been reported. Here we report a case in which extra-articular facet joint injection resulted in paraspinal and epidural abscesses without facet joint infection. A 50-year-old man presenting with acute back pain and fever was admitted to the hospital. He had the history of diabetes mellitus and had undergone the extra-articular facet joint injection due to a facet joint syndrome diagnosis at a private clinic 5 days earlier. Physical examination showed tenderness over the paraspinal region. Magnetic resonance image (MRI) demonstrated the paraspinal abscess around the fourth and fifth spinous processes with an additional epidural abscess compressing the thecal sac. The facet joints were preserved. The laboratory results showed a white blood cell count of 14.9 × 109 per liter, an erythrocyte sedimentation rate of 52mm/hour, and 10.88mg/dL of C-reactive protein. Laminectomy and drainage were performed. The pus was found in the paraspinal muscles, which was communicated with the epidural space through a hole in the ligamentum flavum. Cultures grew Staphylococcus aureus. Paraspinal abscess communicated with epidural abscess is a rare complication of extra-articular facet joint injection demonstrating an abscess formation after an invasive procedure near the spine is highly possible.

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Section: Discussionmentioning

confidence: 77%

Paraspinal Abscess Communicated with Epidural Abscess after Extra-Articular Facet Joint Injection

et al. 2007

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“…Infection, epidural abscess, has also rarely been reported in children and adults after lumbar puncture. 7,8 Treatment typically involves intravenous antibiotics without surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

Low Back and Leg Pain With Refusal to Ambulate in a 6-Year-Old Male

Hellstrand

Hoppa

2016

Clin Pediatr (Phila)

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“…Spinal epidural abscess is a rare condition with an incidence of approximately 1 case per 10,000 to 13,000 hospital admissions [1,4,11]. The incidence of this disease may rise due to increased use of spinal epidural anesthesia or other procedures during which needles are inserted in the region of the spine [1,3,7,10,12]. Predisposing factors for a spinal epidural abscess as identified by previous studies include diabetes mellitus, chronic renal disease, impaired immunocompetence, alcoholism, malignancies, intravenous drug abuse, recent spinal surgery and spinal trauma [1,2,5,6,9].…”

Section: Discussionmentioning

confidence: 99%

Enlargement of a chronic aseptic lumbar epidural abscess by intraspinal injections - a rare cause of progressive paraparesis

Sabel

Felsberg²,

Neuen-Jacob³

et al. 2000

Zentralbl Neurochir

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The frequent use of invasive procedures at the spinal cord such as epidural injections has led to an increased incidence of iatrogenic abscesses. We report the case of a patient who suffered from low back pain. During epidural lumbar injections of steroids the patient developed severe radicular symptoms, resulting in severe paraparesis. We demonstrate the rare cause of this progressive deterioration, being a combination of a preexisting chronic aseptic epidural abscess and an iatrogenic enlargement by repeated epidural injections. MR-Scans demonstrated a mass lesion at the L4/5 vertebral level, which was surgically removed. Histological evaluation revealed the presence of a chronic aseptic spinal epidural abscess with acute bleedings. Histology and MR-Data disclosed multiple deposits of the applied drug within the abscess and in the surrounding paravertebral soft tissue. The authors prove that the cause of the neurological deterioration was due to epidural injections into a preexisting lumbar chronic aseptic epidural abscess. Harmful and unpleasant complications may occur following epidural injections. Though we present a very rare cause of such complications, a careful monitoring of the neurological status of the patient is necessary as well as the early application of MR imaging in the case of deterioration.

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Neurologic complications of lumbar epidural analgesia

Cited by 10 publications

References 0 publications

Paraspinal Abscess Communicated with Epidural Abscess after Extra-Articular Facet Joint Injection

Paraspinal Abscess Communicated with Epidural Abscess after Extra-Articular Facet Joint Injection

Low Back and Leg Pain With Refusal to Ambulate in a 6-Year-Old Male

Enlargement of a chronic aseptic lumbar epidural abscess by intraspinal injections - a rare cause of progressive paraparesis

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