TRANSIENT PARALYSIS ASSOCIATED WITH EPIDURAL STEROID INJECTION

Epidural steroid therapy is a commonly applied ''conservative'' therap y, but it is not inherently benign. Although arachnoiditis, infection, and meningitis have been reported, acute paraplegia has not been repo rted as a complication of either caudal or spinal epidural steroid inj ection. A unique case of transient, profound paralysis after epidural steroid injection is reported here. The procedure was carried out with out fluoroscopic control and was complicated by a puncture of the thec al sack. Radiographic studies demonstrated a focal, space-occupying le sion in the spinal canal at the level corresponding to the neurologic deficit, which spontaneously resolved over the next 2-3 h. Surgical de compression was initially considered and then deferred in favor of obs ervation. The patient recovered motor, sensory, and bowel and bladder function over the next 48 h. The period of recovery was consistent wit h an acute but brief compressive injury and inconsistent with an anest hetic effect. Radiographic studies suggest three possible explanations : (a) inadvertent thecal penetration during injection may have produce d an atypical anesthetic block; (b) loculation of the injected fluid m ay have caused a transient compressive lesion; or (c) intrathecal inje ction may have produced an iatrogenic arachnoid cyst. Although patholo gic confirmation of the cause was not possible, the potential for this alarming complication should be recognized by physicians prescribing epidural steroid therapy. We do not suggest that epidural steroid ther apy is the treatment of choice for patients with multiple back operati ons or that it is efficacious for these patients. Our purpose is to al ert surgeons and therapists to a rare but potentially devastating comp lication and to provide our experience in treating it.