Yuen E C, Layzer R B, Weitz S R, Olney R K
Department of Neurology, University of California, San Francisco 94143, USA.
Neurology. 1995 Oct;45(10):1795-801. doi: 10.1212/wnl.45.10.1795.
We reviewed the clinical features of 12 patients with neurologic complications following lumbar epidural anesthesia or analgesia. Eleven patients experienced lumbosacral radiculopathy or polyradiculopathy and, of these, 10 received epidural anesthesia or analgesia and one received subarachnoid injection of medication after intended epidural anesthesia. One patient suffered a moderately severe thoracic myelopathy in the setting of unintended spinal anesthesia. The two patients with more severe polyradiculopathy had severe lumbar spinal stenosis on MRI. The other patients experienced mild to moderate neurologic deficits most often involving the L-2 root, and MRIs, when performed, were unremarkable. EMG on three patients helped to localize the lesions to the lumbosacral roots and to quantify the extent of axonal loss. Ten patients were ambulatory upon discharge from the hospital and had good neurologic outcome. One patient with severe polyradiculopathy did not improve after 4 years and had severe motor axonal loss based upon electrodiagnostic studies. The patient with a thoracic myelopathy was ambulatory 4 months after onset. Although generally a safe procedure with low frequency of complications, lumbar epidural anesthesia or analgesia occasionally 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.
我们回顾了12例腰椎硬膜外麻醉或镇痛后出现神经并发症患者的临床特征。11例患者出现腰骶神经根病或多神经根病，其中10例接受了硬膜外麻醉或镇痛，1例在硬膜外麻醉后接受了蛛网膜下腔注药。1例患者在意外发生脊髓麻醉的情况下出现中度严重的胸段脊髓病。2例多神经根病较严重的患者在MRI检查中显示有严重的腰椎管狭窄。其他患者出现轻至中度神经功能缺损，最常累及L-2神经根，进行MRI检查时无明显异常。3例患者的肌电图有助于将病变定位到腰骶神经根，并量化轴突损失的程度。10例患者出院时可步行，神经功能预后良好。1例严重多神经根病患者4年后仍未改善，根据电诊断研究显示有严重的运动轴突损失。胸段脊髓病患者发病4个月后可步行。虽然腰椎硬膜外麻醉或镇痛通常是一种安全的操作，并发症发生率较低，但偶尔会导致神经根病或脊髓病等神经后遗症。在存在椎管狭窄或无意中将麻醉剂或镇痛剂注入蛛网膜下腔的情况下，神经并发症可能会更严重。
