Paralysis after transforaminal epidural injection and previous spinal surgery

Regional Anesthesia and Pain Medicine
Marc A Huntoon, David P Martin

Abstract

This case discusses a rare but devastating complication of transforaminal epidural injection. Elements in the patient's history that may be risk factors are discussed. A 64-year-old man was evaluated for chronic low-back pain after multiple spine surgeries. After the most recent surgery, he suffered transient cauda equina symptoms. Because conservative therapy was not helpful for spinal stenosis and neuroclaudication, a left L2 transforaminal epidural injection was attempted, but a posterolateral fusion mass made this procedure impossible. A left L1 transforaminal approach was successful, and 1 mL of iopamidol (Isovue) contrast was injected, followed by 5 mL of a solution of 0.125% bupivacaine and 40 mg of triamcinolone. Approximately 1 to 2 minutes after injection, the patient described discomfort in the lower abdomen, and 1 minute later, he was unable to move his lower extremities. An MRI showed T2 signal change in the conus medullaris gray matter at T11-12, consistent with an acute vascular infarct. Spinal shock protocol with high-dose methylprednisolone was begun without change. More than 4 years later, the patient continues to be troubled by persistent paraparesis and chronic pain. This case report is part of a new and gro...Continue Reading

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