Background: transforaminal epidural steroid injections (TFESI) are commonly used in the conservative treatment of radicular pain. Concern has risen about potential neurological complications, however often it is unclear if a procedure was performed during an ongoing progressive deterioration, or the procedure as such is the causal event.

Methods: retrospective case report

Result : An 83 year old patient presented with subacute L5-S1 radiculopathy and progressive neurogenic claudication due to lumbar spinal stenosis (LSS). A lumbar Magnetic Resonance Imaging (MRI) showed at L3-4 moderate to severe central spinal canal stenosis, at L4-5 anterolisthesis and bilateral foraminal narrowing at L5-S1. We performed a right TFESI at L5 using 40 mg of lidocaine and 40 mg of methylprednisolone acetate. The day after the procedure, the patient developed a cauda equina syndrome and a severe paresis of the right foot. An urgent CT showed additionally at L4-5 a descending gas containing disc extrusion paracentrally on the right side in contact with L5 nerve root

An urgent laminectomy at level L2 to L5 was performed. No signs of bleeding or abscess were found peroperatively. Three months later the pain was significantly reduced and the patient could walk again with a leg orthosis and a rollator.

Conclusions :

Although the pathophysiology is unclear, the progressive neurogenic claudication before the procedure and the presence of a new disc extrusion afterwards suggests a progressive neurological deterioration leading to a cauda equina syndrome. To what extent the TFESI interfered with this process is unclear.

NEUROLOGICAL INJURY AFTER TRANSFORAMINAL EPIDURAL STEROID INJECTION IN A PATIENT WITH PROGRESSIVE NEUROLOGICAL SIGNS: A CASE REPORT