Paraplegia after lumbosacral nerve root block: report of three cases

摘要: Background context: Lumbar nerve root blocks and epidural steroid injections are frequently employed in the management of degenerative conditions lumbar spine, but relatively few papers have been published that address complications associated with these interventions. Serious include abscess, arachnoiditis, hematoma, cerebrospinal fluid fistula hypersensitivity reaction to injectate. Although transient paraparesis has described after inadvertent intrathecal injection, an immediate lasting deficit not previously as sequelae a block. Purpose: We present three cases which either persisting paraplegia or occurred immediately administration block propose mechanism for this devastating unreported complication. Study design/setting: Case reports patients. Patient sample: Three patients, two women one man ranging age from 42 64 years, underwent procedures performed at different facilities, hands injectionists. In each instance, penetration dura was thought occurred. needles were placed transforamenally, L3–4 on left right, third needle tip lateral S1 root. Outcome measures: Patient follow-up data medical office records. Methods: case, placement verified injection contrast media conjunction computerized tomography biplanar fluoroscopy. No backbleeding encountered upon aspiration any procedures. Magnetic resonance imaging (MRI) within 48 hours injury all patients. Results: patient, suddenly ensued instillation solution and, postprocedure MRI revealed increased signal low thoracic spinal cord T2-weighted consistent edema. The sudden onset neurological changes noted point vascular explanation injuries. postulate patients penetrated caused abnormally dominant radiculomedullary artery, recognized anatomical variant. This vessel, also known artery Adamkiewicz, 85% individuals arises between T9 L2, usually left, minority people may arise lower spine rarely even S1. Adamkiewicz travels through neural foramen irrigates anterior artery. Injury it particulate matter into it, what happen commonly used injectates, result infarction cord, producing clinical findings seen patients. Conclusions: who had performance block. rare complication is concurrence uncommon circumstances, presence unusually origin undetected intraarterial procedure needle.