Paraplegia complicating selective steroid injections of the lumbar spine. Report of five cases and review of the literature
- 480 Downloads
Selective steroid injections of the lumbar spine carry a risk of paraplegia of sudden onset. Seven cases have been reported in the English literature since 2002.
Materials and methods
Five new cases have been analyzed, all coming from Paris area centers. Injections were performed between 2003 and 2008. The following items were searched for: location of a previous lumbar spine surgery if any, symptoms indicating the procedure, route of injection, imaging technique used for needle guidance, injection of a contrast medium, type of steroid, other drugs injected if any, paraplegia level, post-procedure MR findings. The current and reported cases were compared.
MR findings were consistent with spinal cord ischemia of arterial origin. The high rate of patients who had been operated on in these cases does not correspond to that of patients undergoing injections. The presence of epidural scar might increase the risk. The foraminal route was the only one involved in nonoperated patients. Foraminal, interlaminar, or juxta-zygoapophyseal routes were used in operated-on patients.
The high rate of French cases when compared to the literature might arise from the almost exclusive use of prednisolone acetate, a molecule with a high tendency to coalesce in macro-aggregates, putting the spinal cord at risk of arterial supply embolization.
KeywordsSpine Therapeutic radiology Spinal cord injury Steroids complications
- 10.Thron AK (1988) Vascular anatomy of the spinal cord. Neuroradiological investigations and clinical syndromes. Springer-Verlag, Wien, pp 8–12Google Scholar
- 13.Osborn AG (1994) Diagnostic neuroradiology. Mosby, St. LouisGoogle Scholar
- 15.Djindjian R, Hurth M, Houdart R (1970) Angiography of the spinal cord. Masson, Paris, pp 1–26Google Scholar
- 18.Desproges-Gotteron R (1955) Contribution à l’étude de la sciatique paralysante. Thèse Médecine N°342, ParisGoogle Scholar
- 19.de Sèze S, Guillaume J, Desproges-Gotteron R, Jurmand SH, Maitre M (1957) Sciatique paralysante (Etude clinique, pathogénique, thérapeutique d’après 100 observations). Sem Hôp Paris 28:548–572Google Scholar
- 22.Balblanc JC, Pretot C, Ziegler F (1998) Vascular complication involving the conus medullaris or cauda equina after vertebral manipulation for an L4-5 disk herniation. Rev Rhum 65:279–282Google Scholar
- 30.Roques CF, Condouret J, Soleihavoup JP, Croute F (1987) Les corticoïdes pour infiltrations intra-articulaires : éléments de choix (puissance, microcristaux, excipient). Rhumatologie 39:187–194Google Scholar
- 34.Berenstein A, Lasjaunias P (1992) Surgical neuroangiography. Springer-Verlag, Heidelberg, pp 113–118Google Scholar