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Spinal Infarct After Lumbar Transforaminal Epidural Steroid Injection

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Challenging Cases and Complication Management in Pain Medicine

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Abstract

Abrupt and lasting paraplegia after an epidural steroid injection is most likely the result of injury, thrombosis, and/or embolization of an aberrantly low-lying artery of Adamkiewicz. This plausibly causes ischemia and infarction of the thoracic spinal cord and the use of particulate steroids has been implicated. Supportive care in the immediate post injury phase and long-term rehabilitation are crucial to adequate patient recovery. In this chapter we make recommendations to avoid this rare but devastating complication.

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References

  1. Houten JK, Errico TJ. Paraplegia after lumbosacral nerve root block: report of three cases. Spine J. 2002;2:70–5.

    Article  PubMed  Google Scholar 

  2. Popescu A, Lai D, Lu A, Gardner K. Stroke following epidural injections—case report and review of literature. J Neuroimaging. 2013;23:118–21.

    Article  PubMed  Google Scholar 

  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;10:1389–94.

    Article  PubMed  Google Scholar 

  4. Thefenne L, Dubecq C, Zing E, et al. A rare case of paraplegia complicating a lumbar epidural infiltration. Ann Phys Rehabil Med. 2010;53:575–83.

    Article  CAS  PubMed  Google Scholar 

  5. Quintero N, Laffont I, Bouhmidi L, et al. Transforaminal epidural steroid injection and paraplegia: case report and bibliographic review. Ann Readapt Med Phys. 2006;49:242–7.

    Article  CAS  PubMed  Google Scholar 

  6. Benzon HT, Chew TL, McCarthy RJ, Benzon HA, Walega DR. Comparison of the particle sizes of different steroids and the effect of dilution: a review of the relative neurotoxicities of the steroids. Anesthesiology. 2007;106:331–8.

    Article  CAS  PubMed  Google Scholar 

  7. MacMahon PJ, Shelly MJ, Scholz D, Eustace SJ, Kavanagh EC. Injectable corticosteroid preparations: an embolic risk assessment by static and dynamic microscopic analysis. AJNR Am J Neuroradiol. 2011;32:1830–5.

    Article  CAS  PubMed  Google Scholar 

  8. Alkabie S, Boileau AJ. The role of therapeutic hypothermia after traumatic spinal cord injury—a systematic review. World Neurosurg. 2015. doi:10.1016/j.wneu.2015.09.079

  9. Rathmell JR, Benzon HT, Dreyfuss P, Huntoon M, et al. Safeguards to prevent neurological complications after epidural steroid injections: consensus opinions from a Multidisciplinary Working Group and national organizations. Anesthesiology. 2015;122:974–84.

    Article  CAS  PubMed  Google Scholar 

  10. Smuck M, Maxwell MD, Kennedy D, Rittenberg JD, Lansberg MG, Plastaras CT. Utility of the anesthetic test dose to avoid catastrophic injury during cervical transforaminal epidural injections. Spine J. 2010;10:857–64.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Anesthesiology, University of Illinois, Chicago, IL, 60612, USA

    Khalid M. Malik M.D.

Authors
  1. Khalid M. Malik M.D.
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Correspondence to Khalid M. Malik M.D. .

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Editors and Affiliations

  1. Department of Anesthesia and Critical Care, University of Chicago Medicine, Chicago, Illinois, USA

    Magdalena Anitescu

  2. Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA

    Honorio T. Benzon

  3. Division of Pain Medicine, Department of Anesthesiology, University of California San Diego School of Medicine, La Jolla, California, USA

    Mark S. Wallace

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Malik, K.M. (2018). Spinal Infarct After Lumbar Transforaminal Epidural Steroid Injection. In: Anitescu, M., Benzon, H., Wallace, M. (eds) Challenging Cases and Complication Management in Pain Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-60072-7_14

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  • DOI: https://doi.org/10.1007/978-3-319-60072-7_14

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-60070-3

  • Online ISBN: 978-3-319-60072-7

  • eBook Packages: MedicineMedicine (R0)

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