European Radiology

, Volume 20, Issue 1, pp 181–189 | Cite as

Paraplegia complicating selective steroid injections of the lumbar spine. Report of five cases and review of the literature

  • Marc Wybier
  • Sandrine Gaudart
  • David Petrover
  • Emmanuel Houdart
  • Jean-Denis Laredo
Interventional

Abstract

Background

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.

Results

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.

Conclusion

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.

Keywords

Spine Therapeutic radiology Spinal cord injury Steroids complications 

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Copyright information

© European Society of Radiology 2009

Authors and Affiliations

  • Marc Wybier
    • 1
    • 4
  • Sandrine Gaudart
    • 2
  • David Petrover
    • 1
  • Emmanuel Houdart
    • 3
  • Jean-Denis Laredo
    • 1
  1. 1.Musculoskeletal Radiology Department, Hôpital LariboisièreAssistance Publique - Hôpitaux de ParisParisFrance
  2. 2.Radiology Department, Hôpital BeaujonAssistance Publique - Hôpitaux de ParisClichyFrance
  3. 3.Neuroradiology Department, Hôpital LariboisièreAssistance Publique - Hôpitaux de ParisParisFrance
  4. 4.Service de Radiologie Ostéo-articulaireHôpital LariboisièreParisFrance

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