Paraplégie à la suite d'une infiltration foraminale lombaire : revue de la littérature à partir d'un cas

Quintero, N.; Laffont, I.; Bouhmidi, L.; Rech, C.; Schneider, A. Even; Gavardin, Thierry; Dizien, O

doi:10.1016/j.annrmp.2006.03.004

Cited by 52 publications

(5 citation statements)

References 24 publications

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“…The lumbar method carries a risk of trauma to the nerve root during needle placement and also includes the risk of paraplegia if steroid is injected into a radicular artery that supplies the anterior spinal artery 24. Furthermore, disc infiltration can be a complication of the lumbar access route as well.…”

Section: Discussionmentioning

confidence: 99%

Caudal epidural steroid injection: a randomized controlled trial

Murakibhavi

Khemka

2011

Evidence-Based Spine-Care Journal

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Study design: Prospective study.Study rationale: A recurrent phenomenon, the lifetime prevalence of low back pain has been reported as 54%–80%, while annual prevalence ranges from 15%–45%.1 It is also associated with enormous economic, societal, and health impact.2 India, being a developing country, has its problem compounded by the occupational compulsions in parts of the rural areas.3For some interventional therapies, like epidural steroid injections, utilization rates have increased dramatically.4,5,6,7,8,9 They have become one of the most commonly performed interventions in the United States for low back pain with radiculopathy.10Clinical question: Multiple systematic reviews,11 a meta-analysis,12 several guidelines,13 health technology assessments by insurers, and local medical review policies and coverage decisions have been published. However, controversy continues regarding the effectiveness of epidural steroid injections. In addition three types of epidurals, namely interlaminar, transforaminal, and caudal, with variable results complicate the picture for practice of interventional pain management. The underlying mechanism of action of epidurally administered steroid and local anesthetic injections is still not well understood and compounds the problem.14Objective: To evaluate and update the effects of caudal epidural injection in the management of chronic low back pain and sciatica.Final Class of evidence-treatmentYesStudy design: RCT• Cohort Case control Case seriesMethods Concealed allocation (RCT)• Intention to treat (RCT)• Blinded/independent evaluation of primary outcome• F/U ≥ 85%• Adequate sample size•Control for confoundingOverall class of evidenceIIThe definiton of the different classes of evidence is available

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Section: Discussionmentioning

confidence: 99%

Caudal epidural steroid injection: a randomized controlled trial

Murakibhavi

Khemka

2011

Evidence-Based Spine-Care Journal

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“…However, other serious complications of cervical transforaminal injection have been recently reported in the literature. These include a wide range of conditions such as spinal cord infarction due to trauma of the anterior spinal artery, cerebellum or brainstem infarction, or even death [3] .…”

Section: Discussionmentioning

confidence: 99%

Rare Case of Ischaemic Stroke Following Cervical Transforaminal Injection

Ali

Khoumsi

Gorur

et al. 2019

European Journal of Case Reports in Internal Medicine

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We report a case of brainstem infarction following a C5–C6 cervical transforaminal injection, a rare and serious neurological complication of this procedure. Cervical transforaminal steroid injection is a common therapy for patients with persistent cervical radiculopathy not relieved by conservative treatment, and is effective in 65–70% of cases. Unfortunately, this procedure may lead to serious complications such as neurological damage. These complications are rare but potentially fatal, as reported in our case. Complications could be due to three mechanisms: the technique itself, the cervical vascular anatomy and the properties of the product (corticoids). The neurological complications can be diagnosed through brain MRI. This case report focuses on the importance of a risk/benefit evaluation when performing this medical procedure. LEARNING POINTS Physicians should be better informed about severe complications following cervical transforaminal epidural steroid injections and their strict indications. Severe adverse events are rare but they can be disastrous. Non-particulate corticosteroid should be used.

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“…In this study, we used a Quincke needle which is sharp. Because blunt needles will displace and not penetrate vessels owing to their dull tip [17,18], the use of blunt needles during TFEB has been suggested to avoid intravascular injection of steroids [7,19]. Animal studies have shown a reduced incidence of arterial puncture and bleeding with the use of blunt needles compared to that using sharp needles [17,18].…”

Section: Discussionmentioning

confidence: 99%

Digital subtraction angiography vs. real-time fluoroscopy for detection of intravascular injection during transforaminal epidural block

Park

Kim

2019

Yeungnam Univ J Med

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BackgroundTransforaminal epidural block (TFEB) is an effective treatment option for radicular pain. To reduce complications from intravascular injection during TFEB, use of imaging modalities such as real-time fluoroscopy (RTF) or digital subtraction angiography (DSA) has been recommended. In this study, we investigated whether DSA improved the detection of intravascular injection during TFEB at the whole spine level compared to RTF.MethodsWe prospectively examined 316 patients who underwent TFEB. After confirmation of final needle position using biplanar fluoroscopy, 2 mL of nonionic contrast medium was injected at a rate of 0.5 mL/s under RTF; 30 s later, 2 mL of nonionic contrast medium was injected at a rate of 0.5 mL/s under DSA.ResultsThirty-six intravascular injections were detected for an overall rate of 11.4% using RTF, with 45 detected for a rate of 14.2% using DSA. The detection rate using DSA was statistically different from that using RTF (p=0.004). DSA detected a significantly higher proportion of intravascular injections at the cervical level than at the thoracic (p=0.009) and lumbar (p=0.011) levels.ConclusionDuring TFEB at the whole spine level, DSA was better than RTF for the detection of intravascular injection. Special attention is advised for cervical TFEB, because of a significantly higher intravascular injection rate at this level than at other levels.

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Paraplégie à la suite d'une infiltration foraminale lombaire : revue de la littérature à partir d'un cas

Cited by 52 publications

References 24 publications

Caudal epidural steroid injection: a randomized controlled trial

Caudal epidural steroid injection: a randomized controlled trial

Rare Case of Ischaemic Stroke Following Cervical Transforaminal Injection

Digital subtraction angiography vs. real-time fluoroscopy for detection of intravascular injection during transforaminal epidural block

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