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Paralysis after transforaminal epidural injection and previous spinal surgery
Marc A Huntoon1, David P Martin
1Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Rochester, MN 55905, USA. huntoon.marc@mayo.edu
Regional Anesthesia and Pain Medicine
|September 17, 2004
Summary
Transforaminal epidural injections, while used for chronic pain, carry a rare risk of devastating spinal vascular injury. This case highlights the potential for severe neurological deficits following the procedure.
Area of Science:
- Neurology
- Pain Management
- Interventional Spine Procedures
Background:
- Transforaminal epidural injections are utilized for managing chronic low-back pain and neuroclaudication.
- A 64-year-old male with a history of multiple spine surgeries presented with persistent symptoms.
- Previous conservative therapies and an attempted L2 injection were unsuccessful.
Observation:
- A subsequent L1 transforaminal epidural injection was performed using contrast, bupivacaine, and triamcinolone.
- Shortly after the injection, the patient experienced lower abdominal discomfort and acute lower extremity paralysis.
- Magnetic Resonance Imaging (MRI) revealed an acute vascular infarct in the conus medullaris.
Findings:
- The patient developed persistent paraparesis and chronic pain, indicating a severe neurological deficit.
- The complication is attributed to a potential spinal vascular injury during the transforaminal injection.
- Despite immediate medical intervention, neurological recovery was not achieved.
Implications:
- This case underscores the potential, albeit rare, risks associated with transforaminal epidural injections.
- Further research is crucial to understand and mitigate the incidence of spinal vascular injuries.
- Ensuring patient safety in interventional pain procedures requires ongoing vigilance and study.