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Serious Neurological Complication Resulting from Inadvertent Intradiscal Injection During Fluoroscopically Guided

Nicolas Amoretti1, Jean Baqué2, Stéphane Litrico2

  • 1Hopital Pasteur 2, service de radiologie interventionnelle, Chu de Nice, 30, voie romaine, 06001, Nice, France. amoretti.n@chu-nice.fr.

Cardiovascular and Interventional Radiology
|January 4, 2019
PubMed

Insights

Inadvertent injection into a herniated disc during epidural steroid procedures can cause severe neurological deficits. Recognizing dynamic disc changes is crucial for patient safety during lumbar procedures.

Area of Science:

  • Neurology
  • Radiology
  • Neurosurgery

Background:

  • Lumbar epidural corticosteroid injections are common for radiculopathy.
  • Magnetic resonance imaging (MRI) is used to guide these procedures.

Observation:

  • A patient with L5 radiculopathy underwent lumbar epidural injection.
  • During the procedure, severe leg pain developed, leading to termination.
  • Immediate paraplegia occurred post-procedure.

Findings:

  • Imaging revealed contrast material within a massive extruded disc fragment.
  • The disc extrusion significantly increased in size compared to pre-injection MRI.
  • This suggests inadvertent intradiscal injection occurred.

Implications:

  • Rare but serious neurological complications, like paraplegia, can arise from lumbar epidural injections.
  • Dynamic changes in disc herniation size between MRI and injection necessitate careful consideration.
  • This case highlights the importance of reassessing imaging findings for patient safety.
Keywords:
Intervertebral disk displacementSpinal cord compressionSpinal injection steroidsSpinal nerve roots

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