Article

We report the case of a patient who developed paraplegia following a
low lumbar epidural steroid injection. Alternative approaches to (or alternative
means of) performing transforaminal injections should be considered, in order to
avoid devastating neurological complications. CASE REPORT: A 54-year-old man (who
had undergone surgery 14 years earlier to cure an L5-S1 slipped disc with right
S1 radiculopathy) presented with low back pain (which had begun 6 weeks
previously) and left S1 radiculopathy. During a second infiltration of
prednisolone acetate, the patient reported feeling a heat sensation in his legs
and concomitantly developed facial flushing. Immediately after the injection, the
patient developed complete, flaccid T7 ASIA A motor and sensory paraplegia. Three
days later, T2 magnetic resonance imaging (MRI) of the spine revealed a
spontaneous hypersignal in the conus medullaris and from T6 to T9, suggesting
medullary ischemia. Recovery has been slow; after 4 months of treatment in a
physical and rehabilitation medicine department, urinary and sensory disorders
are still present (T7 ASIA D paraplegia). The patient can walk 200 m unaided.
Three months later, the MRI data had not changed. DISCUSSION: This is a rare case
report of paraplegia following low lumbar epidural infiltration via an
interlaminar route. The mechanism is not clear. Most of authors suggest that the
pathophysiological basis of this type of complication is ischemia caused by
accidental interruption of the medullary blood supply. Direct damage to a
medullary artery, arterial spasm or corticosteroid-induced occlusion due to
undetected intra-arterial injection could result in medullary infarction. This
serious incident should prompt us to consider how to avoid further problems in
the future. It also raises the issue of providing patients with information on
the risks inherent in this type of procedure. CONCLUSION: Despite the rarity of
this complication, patients should be made aware of its potential occurrence. In
the case reported here, the functional prognosis is uncertain.
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Langue : ANGLAIS