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[Lumbar epidural and foraminal injections: update]

M Wybier1

  • 1Service de Radiologie Ostéo-articulaire, Hôpital Lariboisière, AP-HP, 2 rue Ambroise Paré, 75010 Paris, France. marc.wybier@lrb.aphp.fr

Journal De Radiologie
|September 4, 2010
PubMed

Insights

Fluoroscopy-guided lumbar spine injections can cause paralysis due to arterial ischemia. Prior surgery and specific steroid use, like prednisolone acetate, may increase risks of this serious complication.

Area of Science:

  • Neurology
  • Radiology
  • Interventional Pain Management

Background:

  • Fluoroscopy-guided lumbar spine injections are common procedures.
  • Potential complications include neurological deficits such as paralysis.
  • Understanding risk factors is crucial for patient safety.

Observation:

  • A review of 12 cases (2002-2008) of immediate paralysis following fluoroscopy-guided lumbar spine injections.
  • Magnetic Resonance (MR) imaging revealed spinal cord ischemia of arterial origin in affected patients.
  • Common factors included prior lumbar surgery and specific injection approaches.

Findings:

  • Prior lumbar spine surgery appears to increase the risk of paraplegia, potentially due to scar tissue.
  • Different injection routes (transforaminal, interlaminar, juxta-zygapophyseal) were used, particularly in patients with previous surgery.
  • The frequent use of prednisolone acetate in France may contribute to cases due to its propensity for macro-aggregate formation and subsequent embolization.

Implications:

  • These findings highlight the potential risk of spinal cord ischemia and paralysis after lumbar spine injections.
  • Identifying patients with prior surgery and considering alternative steroid formulations may mitigate risks.
  • Further research into the mechanism of arterial embolization is warranted to improve procedural safety.

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