Persistent cauda equina syndrome after caudal epidural injection under severe spinal stenosis: a case report

Caudal epidural injection (CEI) is one of the most common treatments for low-back pain with sciatica. CEI rarely leads to neurologic complications. We report a case of persistent cauda equina syndrome after CEI. A 44-year-old male patient with severe L4 and L5 spinal ste-nosis underwent CEI for low-...

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Bibliographic Details
Published in:Journal of pain research 2017-01, Vol.10, p.1425-1429
Main Authors: Seo, Young Tak, Kong, Hyun Ho, Lee, Goo Joo, Bang, Heui Je
Format: Article
Language:English
Subjects:
Anesthesia
Anesthesiology
Ankle
Back pain
Care and treatment
Case Report
Case studies
Cauda Equina Syndrome
complications
Complications and side effects
Diagnosis
Electromyography
Emergency medical care
epidural injection
Epidural injections
Nervous system diseases
NMR
Nuclear magnetic resonance
Paralysis
Physical therapy
Risk factors
Spinal stenosis
Surgery
Tomography
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Summary:Caudal epidural injection (CEI) is one of the most common treatments for low-back pain with sciatica. CEI rarely leads to neurologic complications. We report a case of persistent cauda equina syndrome after CEI. A 44-year-old male patient with severe L4 and L5 spinal ste-nosis underwent CEI for low-back pain and sciatica. The CEI solution consisted of bupivacaine, hyaluronidase, triamcinolone acetonide, and normal saline. He experienced motor weakness and sensory loss in both lower extremities and neurogenic bladder for more than 1 year after the procedure. His ankle dorsiflexors, big-toe extensors, and ankle plantar flexors on both sides were checked and categorized as motor-power Medical Research Council grade 0. His bilateral ankle-jerk reflection was absent. An electrophysiological study showed lumbosacral polyradiculopathy affecting both sides of the L5 and S1 nerve roots. A urodynamic study revealed hypoactive neurogenic bladder affecting both sacral roots.
ISSN:1178-7090
1178-7090
DOI:10.2147/JPR.S134636