Ann Rehabil Med.  2015 Jun;39(3):504-507. 10.5535/arm.2015.39.3.504.

Cervical Meningomyelitis After Lumbar Epidural Steroid Injection

• Lee Y
• Kim JS
• Kim JY

• KMID: 2165657
• DOI: http://doi.org/10.5535/arm.2015.39.3.504

Abstract

Epidural steroid injections (ESI) are a common treatment for back pain management. ESI-related complications have increased with the growing number of procedures. We report a case of cervical meningomyelitis followed by multiple lumbar ESI. A 60-year-old male with diabetes mellitus presented to our hospital with severe neck pain. He had a history of multiple lumbar injections from a local pain clinic. After admission, high fever and elevated inflammatory values were detected. L-spine magnetic resonance imaging (MRI) revealed hematoma in the S1 epidural space. Antibiotic treatment began under the diagnosis of a lumbar epidural abscess. Despite the treatment, he started to complain of weakness in both lower extremities. Three days later, the weakness progressed to both upper extremities. C-spine MRI revealed cervical leptomeningeal enhancement in the medulla oblongata and cervical spinal cord. Removal of the epidural abscess was performed, but there was no neurological improvement.

Keyword

Epidural injections; Myelitis; Epidural abscess

MeSH Terms

Back Pain
Diabetes Mellitus
Diagnosis
Epidural Abscess
Epidural Space
Fever
Hematoma
Humans
Injections, Epidural
Lower Extremity
Magnetic Resonance Imaging
Male
Medulla Oblongata
Middle Aged
Myelitis
Neck Pain
Pain Clinics
Spinal Cord
Upper Extremity

Figure

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  Fig. 1 L-spine magnetic resonance imaging data. (A) T2 sagittal view showing bulged disc at L4-5, L5-S1. (B) T2 transverse view showing reticular infiltration at left posterior epidural space of S1.

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  Fig. 2 C-spine magnetic resonance imaging data. (A) T2 sagittal view showing signal change and swelling from medulla oblongata to upper thoracic cord. (B) T1 sagittal view showing leptomeningeal enhancement of medulla oblongata and cervical cord (arrow, epidural fluid collection at upper cervical area).

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  Fig. 3 Post-operative C-spine magnetic resonance imaging data. (A) T2 sagittal view showing meningeal thickening, enhancement of medulla oblongata and cervical cord. (B) T2 transverse view showing loculated fluid collection in posterior arch at the C1 and C2 spine.

Reference

1. Manchikanti L, Pampati V, Falco FJ, Hirsch JA. Assessment of the growth of epidural injections in the medicare population from 2000 to 2011. Pain Physician. 2013; 16:E349–E364. PMID: 23877459.

2. Brisby H. Pathology and possible mechanisms of nervous system response to disc degeneration. J Bone Joint Surg Am. 2006; 88(Suppl 2):68–71. PMID: 16595447.

3. Abdi S, Datta S, Lucas LF. Role of epidural steroids in the management of chronic spinal pain: a systematic review of effectiveness and complications. Pain Physician. 2005; 8:127–143. PMID: 16850050.

4. Joshi SM, Hatfield RH, Martin J, Taylor W. Spinal epidural abscess: a diagnostic challenge. Br J Neurosurg. 2003; 17:160–163. PMID: 12820759.

5. Kim EJ, Moon JY, Park KS, Yoo DH, Kim YC, Sim WS, et al. Epidural steroid injection in Korean pain physicians: a national survey. Korean J Pain. 2014; 27:35–42. PMID: 24478899.

6. Even JL, Crosby CG, Song Y, McGirt MJ, Devin CJ. Effects of epidural steroid injections on blood glucose levels in patients with diabetes mellitus. Spine (Phila Pa 1976). 2012; 37:E46–E50. PMID: 21540770.

7. Nanjayan SK, Swamy GN, Yallappa S, Bommireddy R. Arachnoiditis following caudal epidural injections for the lumbo-sacral radicular pain. Asian Spine J. 2013; 7:355–358. PMID: 24353855.

8. Byun YS, Kim HT, Chang SA, Lee SR, Hwang DH, Kim SH. Iatrogenic spinal infection after injection therapy in spine. J Korean Soc Spine Surg. 2006; 13:299–305.