Serious Neurological Complication Resulting from Inadvertent Intradiscal Injection During Fluoroscopically Guided Interlaminar Epidural Steroid Injection

  • Nicolas AmorettiEmail author
  • Jean Baqué
  • Stéphane Litrico
  • Nicolas Stacoffe
  • William Palmer
Case Report


We describe the case of a 30-year-old patient who was referred for lumbar epidural corticosteroid injection due to right L5 radiculopathy. Two months earlier, MRI demonstrated a right large paracentral L4–L5 disk extrusion causing disabling L5 radiculopathy. The L4–L5 level was selected for interlaminar injection, using fluoroscopic guidance. During injection, the patient developed severe pain in both lower extremities. Thus, the procedure was immediately terminated. Paraplegia occurred within several minutes. Urgent lumbar spine CT and MRI demonstrated contrast material in a massive extruded disk fragment and substantial increase in size of the disk extrusion compared to pre-injection MRI. Emergency surgery was performed for lumbar decompression and discectomy. Although rare, serious neurological complication can result from inadvertent intradiscal injection of contrast material during lumbar epidural injection. This case illustrates the importance of recognizing the possibility of dynamic change in the size of an extruded disk fragment when the MRI precedes injection by a substantial time interval.

Level of Evidence

IV, Case Series.


Spinal injection steroids Spinal nerve roots Spinal cord compression Intervertebral disk displacement 



Magnetic resonance imaging


Cube centimeters


Visual analogue scale


Computerized tomography


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2019

Authors and Affiliations

  • Nicolas Amoretti
    • 1
    Email author
  • Jean Baqué
    • 1
  • Stéphane Litrico
    • 1
  • Nicolas Stacoffe
    • 1
  • William Palmer
    • 2
  1. 1.Hopital Pasteur 2, service de radiologie interventionnelleChu de NiceNiceFrance
  2. 2.MGH Harvard Medical SchoolBostonUSA

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