A rare case of paraplegia complicating a lumbar epidural infiltration
| Autor: | O. Berets, D. Rogez, G. Defuentes, E. Lapeyre, C. Dubecq, E. Escobar, L. Thefenne, E. Zing, M. Soula |
|---|---|
| Rok vydání: | 2010 |
| Předmět: |
Male
Complications Embolism Anti-Inflammatory Agents Sciatica Muscle Hypertonia Orthopedics and Sports Medicine Radiculopathy Degenerative disc disease Informed Consent Lumbar Vertebrae Paraplégie Rehabilitation Arteries Hernie discale Middle Aged Low back pain Magnetic Resonance Imaging Infiltration épidurale medicine.anatomical_structure Corticoïdes Anesthesia Muscle Hypotonia medicine.symptom Paraplegia medicine.medical_specialty Lombosciatalgie Sacrum Medullary cavity Prednisolone Injections Epidural Models Biological Medullary Artery Lumbar medicine Flushing Corticosteroids Humans Medullary ischemia business.industry Spinal Cord Ischemia medicine.disease Epidural injection Surgery Conus medullaris business Low Back Pain |
| Zdroj: | Annals of Physical and Rehabilitation Medicine. 53(9):575-583 |
| ISSN: | 1877-0657 |
| DOI: | 10.1016/j.rehab.2010.08.029 |
| Popis: | Objective We report the case of a patient who developed paraplegia following a low lumbar epidural steroid injection. Alternative approaches to (or alternative means of) performing transforaminal injections should be considered, in order to avoid devastating neurological complications. Case report A 54-year-old man (who had undergone surgery 14 years earlier to cure an L5-S1 slipped disc with right S1 radiculopathy) presented with low back pain (which had begun 6 weeks previously) and left S1 radiculopathy. During a second infiltration of prednisolone acetate, the patient reported feeling a heat sensation in his legs and concomitantly developed facial flushing. Immediately after the injection, the patient developed complete, flaccid T7 ASIA A motor and sensory paraplegia. Three days later, T2 magnetic resonance imaging (MRI) of the spine revealed a spontaneous hypersignal in the conus medullaris and from T6 to T9, suggesting medullary ischemia. Recovery has been slow; after 4 months of treatment in a physical and rehabilitation medicine department, urinary and sensory disorders are still present (T7 ASIA D paraplegia). The patient can walk 200 m unaided. Three months later, the MRI data had not changed. Discussion This is a rare case report of paraplegia following low lumbar epidural infiltration via an interlaminar route. The mechanism is not clear. Most of authors suggest that the pathophysiological basis of this type of complication is ischemia caused by accidental interruption of the medullary blood supply. Direct damage to a medullary artery, arterial spasm or corticosteroid-induced occlusion due to undetected intra-arterial injection could result in medullary infarction. This serious incident should prompt us to consider how to avoid further problems in the future. It also raises the issue of providing patients with information on the risks inherent in this type of procedure. Conclusion 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect