Transforaminal epidural steroid injection can result in further neurological injury in a patient with severe foraminal stenosis and nerve impingement

Surgical Neurology International
Ramsis F GhalyNebojsa Nick Knezevic

Abstract

Chronic low back pain (LBP) is highly prevalent and costly in our society. The use of epidural steroid injections (ESIs) for the treatment of radicular LBP is very widespread and continues to rise. The most popular injection is the lumbar/sacral transforaminal epidural steroid injection (TFESI). Here, we present a serious neurological complication resulting from such a TFESI that was only reversed by timely neurosurgical intervention. A 49-year-old male presented with a 5-year history of progressive neurogenic claudication and right lower extremity pain/radiculopathy. He had previously received multiple lumbar ESIs and other conservative therapy. Due to a recent exacerbation of his radiculopathy associated with MRI-documented lumbosacral spondylosis, he underwent a right L5/S1 TFESI under fluoroscopic guidance. This resulted in acute right lower extremity weakness accompanied by a right-sided foot drop and sphincter dysfunction. Although the follow-up MRI was noncontributory, the EMG showed L5/S1 denervation, and the patient underwent an L4-5, L5-S1 laminectomy with discectomies at the L4-5 and L5-S1 levels. Immediately after the surgery, the patient's weakness and sensory deficits improved. Two years later, the patient continu...Continue Reading

References

Sep 17, 2004·Regional Anesthesia and Pain Medicine·Marc A Huntoon, David P Martin

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Citations

May 28, 2019·Regional Anesthesia and Pain Medicine·Nathan ClementsZachary L McCormick
Mar 13, 2019·Joint, Bone, Spine : Revue Du Rhumatisme·Hervé BardJean-Denis Laredo

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