Cauda equina syndrome after epidural steroid injection: a case report

Area of Science:

• Neurology
• Pain Management
• Anesthesiology

Background:

• Lumbosacral radiculopathy is commonly treated with physical therapy, medications, and injections.
• Epidural steroid injections are a standard treatment for radicular pain.
• Cauda equina syndrome is a serious but rare complication of epidural procedures.

Observation:

• A 50-year-old woman experienced perineal numbness and lower extremity weakness hours after an epidural injection of triamcinolone and bupivacaine for radiculopathy.
• Neurologic evaluation revealed saddle anesthesia, decreased sensation, and motor weakness.
• The patient also presented with urinary retention.

Findings:

• The patient's symptoms, consistent with cauda equina syndrome, resolved spontaneously within 8 hours.
• This case suggests a possible, though rare, link between epidural triamcinolone/bupivacaine and transient cauda equina syndrome.
• No specific intervention was required beyond supportive care and monitoring.

Implications:

• Highlights the importance of vigilance for neurologic deterioration following epidural steroid injections.
• Emphasizes the need for thorough clinical examination and patient monitoring post-procedure.
• Underscores that while rare, severe complications like cauda equina syndrome should be considered.