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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
  • 22 Downloads

Abstract

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.

Keywords

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

Abbreviations

MRI

Magnetic resonance imaging

Cc

Cube centimeters

VAS

Visual analogue scale

CT

Computerized tomography

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    William E, Palmer MD. Spinal injections for pain management. Radiology. 2016;281(3):669–88.CrossRefGoogle Scholar
  2. 2.
    Valat J-P, Rozenberg S. Local corticosteroid injections for low-back pain and sciatica. Revue du Rhumatisme. 2008;75:590–5.CrossRefGoogle Scholar
  3. 3.
    Kennedy DJ, Dreyfuss P, Aprill CN, Bogduk N. Paraplegia following image-guided transforaminal lumbar spine epidural steroid injection: two case reports. Pain Med. 2009;10(8):1389–94.CrossRefGoogle Scholar
  4. 4.
    Botwin KP, Gruber RD, Bouchlas CG, Torres-Ramos FM, Freeman TL, Slaten WK. Complications of fluoroscopically guided transforaminal lumbar epidural injections. Arch Phys Med Rehabil. 2000;84:1045–50.CrossRefGoogle Scholar
  5. 5.
    Bardin T, Kuhn MF, Kuntz D, Meyer O, Orcel P. Complications infectieuses des infiltrations rachidiennes. In: Actual Rhumatol. 2002. p. 294.Google Scholar
  6. 6.
    Goodman BS, Posecion LWF, Mallempati S, Bayazitoglu M. Complications and pitfalls of lumbar interlaminar and transforaminal epidural injections. Curr Rev Musculoskelet Med. 2008;1(3–4):212–22.CrossRefGoogle Scholar
  7. 7.
    Windsor RE, Storm S, Sugar R. Prevention and management of complications from common spinal injections. Pain Physician. 2003;6:473–83.PubMedGoogle Scholar
  8. 8.
    Nam KH, Choi CH, Yang MS, Kang DW. Spinal epidural hematoma after pain control procedure. J Korean Neurosurg Soc. 2010;48(3):281–4.CrossRefGoogle Scholar
  9. 9.
    Vos PE, De Boer WA, Wurzer JAL, Van Gijn J. Subdural hematoma after lumbar puncture: two case reports and review of the literature. Clin Neurol Neurosurg. 1991;93(2):127–32.CrossRefGoogle Scholar
  10. 10.
    Van De Kelft E, Bosmans J, Parizel PM, Vyve M, Selosse P. Intracerebral hemorrhage after lumbar myelography iohexol: report of a case and review of the litterature. Neurosurgery. 1991;28:570–4.CrossRefGoogle Scholar
  11. 11.
    Windsor RE, Storm S, Sugar R, Nagula D. Cervical transforaminal injection: review of the literature, complications, and a suggested technique. Pain Physician. 2003;6(4):457–65.PubMedGoogle Scholar

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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