New-Onset Paralysis following Biopsy of a Retroperitoneal Mass with Intraspinal Extension in a Pediatric Patient.

Image-guided percutaneous biopsies are routine, safe procedures and complications are infrequent and usually directly related to the biopsy itself. This report describes a biopsy of a retroperitoneal mass with extension into the spinal canal, following which the patient developed paralysis unrelated to the biopsy itself but secondary to spinal cord ischemia during the procedure. Multiple factors contributed to the ischemia, including prone positioning, compression of spinal vasculature by the mass, low arterial pressures, and an extended duration of anesthesia. While the patient eventually recovered neurologic function, it is an important reminder to consider individual patient factors that may complicate typically routine procedures. In masses with intraspinal extension, patient positioning is critical to prevent positional ischemia, and maintaining elevated mean arterial pressures is crucial for ensuring adequate spinal perfusion throughout the procedure.