NEUROLOGIC COMPLICATIONS OF LUMBAR EPIDURAL-ANESTHESIA AND ANALGESIA

We reviewed the clinical features of 12 patients with neurologic compl ications following lumbar epidural anesthesia or analgesia. Eleven pat ients experienced lumbosacral radiculopathy or polyradiculopathy and, of these, 10 received epidural anesthesia or analgesia and one receive d subarachnoid injection of medication after intended epidural anesthe sia. One patient suffered a moderately severe thoracic myelopathy in t he setting of unintended spinal anesthesia. The two patients with more severe polyradiculopathy had severe lumbar spinal stenosis on MRI. Th e other patients experienced mild to moderate neurologic deficits most often involving the L-2 root, and MRIs. when performed, were unremark able. EMG on three patients helped to localize the lesions to the lumb osacral roots and to quantify the extent of axonal loss. Ten patients were ambulatory upon discharge from the hospital and had good neurolog ic outcome. One patient with severe polyradiculopathy did not improve after 4 years and had severe motor axonal loss based upon electrodiagn ostic studies. The patient with a thoracic myelopathy was ambulatory 4 months after onset. Although generally a safe procedure with low freq uency of complications, lumbar epidural anesthesia or analgesia occasi onally causes neurologic sequelae such as radiculopathy or myelopathy. Neurologic complications may be more severe in the presence of spinal stenosis or after inadvertent subarachnoid injection of anesthetic or analgesic agent.