Journal Article

36426 Unilateral paresis after safe triangle approach for transforaminal epidural steroid injection

Savas, Gözde, Kilic, Aslihan Gülec, Tokgöz, Nil, Ozdemir, Alparslan Muhammed, Akçalı, Didem Tuba, Celik, Gözde

2023

Overview

Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)Application for ESRA Abstract Prizes: I apply as an Anesthesiologist (Aged 35 years old or less)Background and Aims Cancer pain is most of the times relieved by pharmacological treatment. When pharmacological treatment is not sufficient, interventional pain procedures are considered. Here we present a case complicated by epidural hematoma.Methods58 years old female patient with stage 4 metastatic colon and urethelial carcinoma was referred to our clinic for hip and leg pain. She had multiple bone metastasis. Medical treatment was not enough, so transforaminal epidural steroid injection (TFESI) and lumbar sympathectomy was offered. The needle was fluoroscopically aimed for left L2 TFESI through the ‘safe’ triangle. Needle insertion happened to be intravascular with spontaneous return of blood. It was decided not to proceed further with the injection. Other interventions were performed uneventfully.Results12 hours later, the patient experienced left-sided sensorimotor loss. Left lower extremity examination revealed 0/5 motor functions of left hip and knee extension and flexion with hypoesthesia from T10 to L2 dermatome were noted. Sensorimotor function of the right lower extremities were normal. Urgent thoracolumbar MRI revealed left sided epidural hematoma extending from T8 to L2 (figure 1 ). Emergent epidural hematoma decompression surgery was offered, which she declined due to her comorbidities.Abstract #36426 Figure 1Epidural hematoma extending from T8 to L2 level, compressing spinal cord. Sacral metastases can also be seen[Figure omitted. See PDF]ConclusionsAlthough lumbar TFESI was found to be safe, we experienced an epidural hematoma, which we believe was because the ‘safe’ triangle approach was chosen, where blood vessels lie. To our knowledge, our case is the first one to report unilateral paresis following a massive epidural hematoma. We believe, Kambin’s triangle approach may prevent from, a rare but debilitating complication, epidural hematoma.

• Publisher: BMJ Publishing Group LTD
• Subject: Epidural / Hematoma / Paresis / Steroids