scholarly journals Spinal Cord Injury by Direct Damage During CT-Guided C7 Transforaminal Epidural Steroid Injection

2018 ◽  
Vol 97 (7) ◽  
pp. e62-e64 ◽  
Author(s):  
Min Cheol Chang
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Steroid Injection ◽  
Epidural Steroid Injection ◽  
Ct Guided ◽  
Direct Damage ◽  
Cord Injury ◽  
Transforaminal Epidural Steroid Injection ◽  
Epidural Steroid

Paraplegia Following Epidural Steroid Injection

2016 ◽  
Author(s):  
Devin Peck
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Epidural Hematoma ◽  
Epidural Abscess ◽  
Steroid Injection ◽  
Epidural Steroid Injection ◽  
Anterior Spinal Artery ◽  
Cord Injury ◽  
Artery Of Adamkiewicz ◽  
Epidural Steroid

Paraplegia following epidural steroid injection is, fortunately, an exceedingly rare complication. The differential diagnosis includes epidural hematoma, spinal cord injury/infarction, epidural abscess, and conversion disorder. Less likely diagnoses include worsening of underlying pathology, a new compressing lesion, or subarachnoid injection. The artery of Adamkiewicz enters the spinal canal via the neural foramen and provides blood supply to the lower two thirds of the spinal cord via the anterior spinal artery. Avoidance of the artery during a transforaminal epidural steroid injection is facilitated by entering the inferior portion of the foramen. Acute management of neurologic complications arising from an epidural steroid injection is facilitated by rapid identification of etiology. In the case of epidural hematoma, avoidance of permanent deficit is more likely when patients undergo prompt decompression. The role of intravenous steroids in acute spinal cord injury is controversial. Chronic management includes extensive rehabilitation, including physical and occupational therapy. Treatment of musculoskeletal nociceptive pain, such as due to shoulder overuse, and neuropathic pain is vital to optimize the patient’s participation in rehabilitative therapy.   Keywords: Epidural Steroid Injection; Complications; Spinal Cord Injury; Epidural Hematoma; Epidural Abscess; Artery of Adamkiewicz; Anterior Spinal Artery Syndrome; Particulate Steroid; Fluoroscopic Guidance

scholarly journals Spinal Cord Infarction after Cervical Transforaminal Epidural Steroid Injection: Case Report and Literature Review

2017 ◽  
Vol 9 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Jangsup Moon ◽  
Hyung-Min Kwon
Keyword(s):  
Spinal Cord ◽  
Steroid Injection ◽  
Cervical Radiculopathy ◽  
Epidural Steroid Injection ◽  
Spinal Cord Infarction ◽  
Catastrophic Event ◽  
History Of ◽  
Transforaminal Epidural Steroid Injection ◽  
Active Rehabilitation ◽  
Epidural Steroid

Introduction: Transforaminal epidural steroid injection (TFESI) is a widely used nonsurgical procedure in the treatment of patients with radiculopathy. It is efficacious in relieving pain, but a number of complications are being reported. Recently, increasing frequency of major complications, such as spinal cord infarction and cerebral infarction, has been reported with the use of a particulate steroid within fluoroscopic-guided procedures. Methods: We report a 49-year-old man with a history of chronic cervical radiculopathy, who experienced a devastating complication after TFESI. Results: After 2 min of regular TFESI, the patient abruptly experienced muscle weakness in both upper extremities and within 5 min the patient became quadriplegic. Despite active rehabilitation, the patient remained bed-ridden 4 years after the catastrophic event. To our knowledge, this is the first reported case of spinal cord infarction that occurred after TFESI in Korea. Conclusion: Considering the risk of dreadful complications, which appear in an unpredictable manner, TFESI with fluoroscopic guidance should be done only with a nonparticulate steroid.

scholarly journals CT-guided transforaminal epidural steroid injection for discogenic lumbar radiculopathy: influence of contrast dispersion and radiologist’s experience on clinical outcome

2021 ◽  
Author(s):  
Christoph Germann ◽  
Dimitri N. Graf ◽  
Benjamin Fritz ◽  
Reto Sutter
Keyword(s):  
Pain Relief ◽  
Steroid Injection ◽  
Pain Reduction ◽  
Therapeutic Outcome ◽  
Epidural Steroid Injection ◽  
Dispersion Pattern ◽  
Ct Guided ◽  
Transforaminal Epidural Steroid Injection ◽  
Epidural Steroid ◽  
The Impact

Abstract Objective To investigate the impact of contrast dispersion pattern/location during lumbar CT-guided transforaminal epidural steroid injection (TFESI) and experience of the performing radiologist on therapeutic outcome. Materials and methods In this single-center retrospective cohort study, two observers analyzed contrast dispersion during CT-guided TFESI of 204 patients (age 61.1 ± 14 years) with discogenic unilateral single-level L4 or L5 radiculopathy. The contrast dispersion pattern was classified as “focal,” “linear,” or “tram-track”; the location was divided into “extraforaminal,” “foraminal,” or “recessal.” Pain was assessed before and 4 weeks after treatment using a numerical rating scale (0, no pain; 10, intolerable pain). Additionally, the patient global impression of change (PGIC) was assessed. The TFESI was performed by musculoskeletal radiologists (experience range: first year of musculoskeletal fellowship training to 19 years). Contrast pattern/location and radiologist’s experience were compared between “good responder” (≥ 50% pain reduction) and “poor responder” (< 50%). A p-value < 0.05 was considered to be statistically significant. Results Overall, CT-guided TFESI resulted in a substantial pain reduction in 46.6% of patients with discogenic radiculopathy. The contrast dispersion pattern and location had no effect on pain relief (p = 0.75 and p = 0.09) and PGIC (p = 0.70 and p = 0.21) 4 weeks after TFESI. Additionally, the experience of the radiologist had no influence on pain reduction (p = 0.92) or PGIC (p = 0.75). Regarding pre-interventional imaging findings, both the location and grading of nerve compression had no effect on pain relief (p = 0.91 and p = 0.85) and PGIC (p = 0.18 and p = 0.31). Conclusion Our results indicate that neither contrast agent dispersion/location nor the experience of the radiologist allows predicting the therapeutic outcome 4 weeks after the procedure.

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