Korean J Pain.  2015 Apr;28(2):144-147. 10.3344/kjp.2015.28.2.144.

Acute Motor Weakness of Opposite Lower Extremity after Percutaneous Epidural Neuroplasty

• Lim YS
• Jung KT
• Park CH
• Wee SW
• Sin SS
• Kim J

• KMID: 2278279
• DOI: http://doi.org/10.3344/kjp.2015.28.2.144

Abstract

Recently, percutaneous epidural neuroplasty has become widely used to treat radicular pain caused by spinal stenosis or a herniated intervertebral disc. A 19-year-old female patient suffering from left radicular pain caused by an L4-L5 intervertebral disc herniation underwent percutaneous epidural neuroplasty of the left L5 nerve root using a Racz catheter. After the procedure, the patient complained of acute motor weakness in the right lower leg, on the opposite site to where the neuroplasty was conducted. Emergency surgery was performed, and swelling of the right L5 nerve root was discovered. The patient recovered her motor and sensory functions immediately after the surgery. Theoretically, the injection of a large volume of fluid in a patient with severe spinal stenosis during epidural neuroplasty can increase the pressure on the opposite side of the epidural space, which may cause injury of the opposite nerve by barotrauma from a closed compartment. Practitioners should be aware of this potential complication.

Keyword

Epidural; Herniation; Monoplegia; Neuroplasty; Radicular pain; Stenosis

MeSH Terms

Barotrauma
Catheters
Constriction, Pathologic
Emergencies
Epidural Space
Female
Hemiplegia
Humans
Intervertebral Disc
Leg
Lower Extremity*
Sensation
Spinal Stenosis
Young Adult

Figure

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  Fig. 1 Preoperative lumbar magnetic resonance imaging. Sagittal view (A) and axial view (B).

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  Fig. 2 Intraoperative fluoroscopic imaging. AP view (A) and lateral view (B). The tip of the Racz catheter was placed in the left lumbar 5 nerve root.

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  Fig. 3 Lumbar magnetic resonance imaging after epidural neuroplasty. Sagittal view (A) and axial view (B). No gross interval change since the previous MRI.

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