Anesth Pain Med.  2021 Jan;16(1):96-102. 10.17085/apm.20068.

Paraplegia after transforaminal epidural steroid injection in a patient with severe lumbar disc herniation - A case report -

• Jeon SH
• Jang W
• Kim SH
• Cho YH
• Lee HS
• Ko HC

• KMID: 2512287
• DOI: http://doi.org/10.17085/apm.20068

Abstract

Background
Transforaminal epidural steroid injection (TFESI) is a conservative treatment for patients with lumbar disc herniation (LDH). However, there are reports of various complications that can occur after TFESI; among these, paraplegia is a serious complication. Case: A 70-year-old woman who was unable to lie supine due to low back pain exacerbation during back extension underwent TFESI. After injection, there was pain relief and the patient was able to lie supine; however, paraplegia developed immediately. Magnetic resonance imaging confirmed cauda equina syndrome (CES) due to nerve compression from L1–2 LDH. We determined that the patient's LDH was already severe enough to be considered CES and that the TFESI procedure performed without an accurate understanding of the patient's condition aggravated the disease.
Conclusions
It is important to accurately determine the cause of pain and disease state of a patient to establish a correct treatment plan before TFESI is performed.

Keyword

Cauda equina syndrome; Epidural injection; Herniated lumbar disc; Paraplegia

Figure

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  Fig. 1. (A) Anteroposterior view fluoroscopy shows the needle, which was inserted under the L1 lumbar pedicle. (B) Lateral view fluoroscopy shows the contrasting agent spreading from the L1–2 neural foramen into the epidural space.

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  Fig. 2. (A) Lumbar sagittal T2-weighted magnetic resonance imaging shows compression of the cauda equina due to L1–2 lumbar disc herniation (white arrow). Conus medullaris (black arrow). (B) Lumbar axial T2-weighted magnetic resonance image showing compression of the cauda equina due to L1–2 lumbar disc herniation.

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  Fig. 3. Anteroposterior view (A) and lateral view (B) lumbar X-ray images taken after surgery.

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