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Updated: Jun 9, 2026

Transforaminal Full-Endoscopic Lumbar Foraminotomy Under Local Anesthesia for L5/S1 Adjacent Segment Foraminal Stenosis

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[Lumbar epidural and foraminal injections: update].

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

Summary

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.

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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.