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Perineural Hematoma Following Lumbar Transforaminal Steroid Injection Causing Acute‐on‐Chronic Lumbar Radiculopathy: A Case Report
Author(s) -
Desai Mehul J,
Dua Shivani
Publication year - 2014
Publication title -
pain practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 58
eISSN - 1533-2500
pISSN - 1530-7085
DOI - 10.1111/papr.12047
Subject(s) - medicine , surgery , sensory loss , hematoma , weakness , epidural steroid injection , lumbar , paraplegia , nerve root , anesthesia , low back pain , spinal cord , alternative medicine , pathology , psychiatry
Transforaminal epidural steroid injections ( TFESI ) are commonly performed for the treatment of lumbar herniated nucleus pulposus and lumbosacral radiculopathy. Although rare, documented complications including spinal cord infarction, paraparesis, epidural abscess, paraplegia, and epidural hematoma have been reported. Here, we present a case of perineural hematoma affecting the L 4 nerve root resulting in progressive acute‐on‐chronic lumbar radiculopathy following TFESI . Case Report A 72‐year‐old female presented with 3 months of low back and right anterior thigh pain. She subsequently underwent right L 3 and L 4 TFESI for physical examination findings concordant with radiographic right foraminal stenosis at L 3‐4 and L 4‐5 with L 3‐4 spondylolisthesis. Over the following week, the patient reported progressive right lower extremity weakness, worsening sensory loss, and ambulatory dysfunction. Examination revealed mild L 3/4 myotomal weakness, sensory changes, and areflexia at the right patella. A gadolinium‐enhanced MRI was ordered, which showed focal abnormal signal with involvement of the right L 4‐ L 5 neuroforamina and extending slightly far laterally, consistent with a small hematoma, affecting the L 4 nerve root. Within 2 months, her strength and reflexes normalized and sensory loss diminished following medical management. Discussion Although extremely rare, perineural or foraminal hematomas may occur as a serious complication of TFESI , even in the setting of a standardized procedure. Hematoma may cause worsening of symptoms in the acute and subacute phase following TFESI . Further investigation into the etiologies of such injuries is warranted and must be added to the considerations of pain physicians performing these procedures.