Imaging and outcome in severe complications of lumbar epidural anaesthesia: report of 16 cases

We reviewed the clinical and neuroradiological features in 16 patients with serious neurological complications of lumbar epidural anaesthesia. We obse rved acute, transient or permanent and delayed complications. Four patients had symptoms immediately after the procedure. One patient developed a suba cute flaccid paraparesis. Two other patients had infectious spondylodisciti s at lumbar puncture level. Eight patients had a delayed progressive spasti c paraparesis and were found to have subarachnoid cysts and irregularities of the surface of the spinal cord consistent with arachnoiditis; six of the m had an extensive, complex syrinx within the cord. One patient had a sever e lumbar polyradiculopathy, and MRI showed adhesive arachnoiditis involving the cauda equina. Although epidural anaesthesia is generally considered sa fe, rare but severe complications, such as radiculopathy, infectious diseas e, myelopathy from ischemia and arachnoiditis with a syrinx may occur. The patients with arachnoiditis had a relentless progression of the disease and a poor outcome: five are confined to a wheelchair, one is bedridden. Compl ications of epidural anaesthesia are easily recognised when they develop im mediately; their relationship to the anaesthesia may be ignored or underest imated when they appear after a delay. Awareness of the possibility of dela yed complications is important.