Transforaminal epidural steroid injection can lead to additional neurological damage in a affected person with extreme foraminal stenosis and nerve impingement.
Surg Neurol Int. 2018;9:159
Authors: Ghaly RF, Zouki T, Pynadath A, Candido KD, Knezevic NN
Background: Power low again ache (LBP) is very prevalent and expensive in our society. The usage of epidural steroid injections (ESIs) for the remedy of radicular LBP could be very widespread and continues to rise. The most well-liked injection is the lumbar/sacral transforaminal epidural steroid injection (TFESI). Right here, we current a severe neurological complication ensuing from such a TFESI that was solely reversed by well timed neurosurgical intervention.
Case Description: A 49-year-old male introduced with a 5-year historical past of progressive neurogenic claudication and proper decrease extremity ache/radiculopathy. He had beforehand acquired a number of lumbar ESIs and different conservative remedy. As a consequence of a latest exacerbation of his radiculopathy related to MRI-documented lumbosacral spondylosis, he underwent a proper L5/S1 TFESI beneath fluoroscopic steerage. This resulted in acute proper decrease extremity weak point accompanied by a right-sided foot drop and sphincter dysfunction. Though the follow-up MRI was noncontributory, the EMG confirmed L5/S1 denervation, and the affected person underwent an L4-5, L5-S1 laminectomy with discectomies on the L4-5 and L5-S1 ranges. Instantly after the surgical procedure, the affected person’s weak point and sensory deficits improved. Two years later, the affected person continued to do effectively with out proof of recurrence of indicators or signs of lumbosacral radiculopathy.
Conclusion: Sufferers needs to be endorsed concerning the threat and advantages of TFESI. Surgical remedy could also be warranted in sufferers who develop acutely progressive worsening following these non-FDA (Meals/Drug Administration) permitted injections.
PMID: 30159203 [PubMed]