Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, FL 32607, USA.
Pain Med. 2009 Nov;10(8):1389-94. doi: 10.1111/j.1526-4637.2009.00728.x. Epub 2009 Oct 26.
To present two case reports of a rare but devastating injury after image-guided, lumbar transforaminal injection of steroids, and to explore features in common with previously reported cases.
Image (fluoroscopic and computed tomography [CT])-guided, lumbar transforaminal injections of corticosteroids have been adopted as a treatment for radicular pain. Complications associated with these procedures are rare, but can be severe.
An 83-year-old woman underwent a fluoroscopically guided, left L3-L4, transforaminal injection of betamethasone (Celestone Soluspan). A 79-year-old man underwent a CT-guided, right L3-L4, transforaminal injection of methylprednisolone (DepoMedrol). Both patients developed bilateral lower extremity paralysis, with neurogenic bowel and bladder, immediately after the procedures. Magnetic resonance imaging scans were consistent with spinal cord infarction. There was no evidence of intraspinal mass or hematoma.
These cases consolidate a pattern emerging in the literature. Distal cord and conus injury can occur following transforaminal injections at lumbar levels, whether injection is on the left or right. This conforms with the probability of radicular-medullary arteries forming an arteria radicularis magna at lumbar levels. All cases used particulate corticosteroids, which promotes embolization in a radicular artery as the likely mechanism of injury. The risk of this complication can be reduced, and potentially eliminated, by the utilization of particulate free steroids, testing for intra-arterial injection with digital subtraction angiography, and a preliminary injection of local anesthetic.
报告两例罕见但严重的类固醇腰椎经皮椎间孔注射后影像学引导损伤的病例，并探讨与以往报道病例的共同特征。
影像学（透视和计算机断层扫描 [CT]）引导的腰椎经皮椎间孔注射皮质类固醇已被采用为神经根痛的治疗方法。与这些程序相关的并发症很少见，但可能很严重。
一名 83 岁女性接受了透视引导的左侧 L3-L4 经皮椎间孔注射倍他米松（Celestone Soluspan）。一名 79 岁男性接受了 CT 引导的右侧 L3-L4 经皮椎间孔注射甲泼尼龙（DepoMedrol）。两名患者在手术后立即出现双侧下肢瘫痪，伴有神经性肠和膀胱。磁共振成像扫描与脊髓梗死一致。没有蛛网膜下腔肿块或血肿的证据。
这些病例巩固了文献中出现的一种模式。经皮椎间孔注射在腰椎水平时，无论是左侧还是右侧，都可能导致远段脊髓和圆锥损伤。这符合神经根髓动脉在腰椎水平形成大神经根动脉的概率。所有病例均使用颗粒状皮质类固醇，这可能导致神经根动脉栓塞，成为损伤的机制。通过使用无颗粒类固醇、数字减影血管造影术检测动脉内注射以及局部麻醉的初步注射，可以降低这种并发症的风险，并可能消除这种风险。
