[Paraplegia after interlaminar epidural steroid injection: a case report]
1Service de chirurgie orthopédique, hôpital Beaujon, Assistance publique-Hôpitaux de Paris, 100, boulevard du Général-Leclerc, 92110 Clichy, France.
Revue De Chirurgie Orthopedique Et Reparatrice De L'Appareil Moteur
|November 6, 2008
Summary
A rare case of paraplegia occurred after an epidural steroid injection in the upper spine. This complication, potentially due to artery injury, highlights risks associated with spinal procedures.
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Background:
- A 42-year-old male with a history of lumbar spine surgery for stenosis experienced recurrent radiculalgia.
- The patient underwent a radio-guided epidural steroid injection at the L1-L2 interlaminar space for pain management.
Observation:
- Immediately post-injection, the patient developed T12-level paraplegia.
- Imaging revealed a discal herniation at L2 without dural sac injury.
- Emergency surgery for radicular release was unsuccessful.
Findings:
- A high-intensity intramedullary signal in the medullary cone on T2 MRI indicated ischemia.
- The diagnosis of medullary cone ischemia was established, likely due to injury to a dominant radiculomedullary artery.
Implications:
- This case represents the first reported instance of paraplegia following an *intralaminar* epidural steroid injection in the upper spine.
- While similar complications have been noted after foraminal injections, this underscores a previously undescribed risk associated with intralaminar approaches.
- Highlights the importance of considering vascular compromise as a potential mechanism for severe neurological deficits after epidural interventions.
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