Original article / Article original A rare case of paraplegia complicating a lumbar epidural infiltration Un cas rare de paraplégie compliquant une infiltration épidurale lombaire par voie interépineuse L. Thefenne a, * , C. Dubecq b , E. Zing b , D. Rogez c , M. Soula b , E. Escobar b , G. Defuentes b , E. Lapeyre c , O. Berets b a Service de me ´decine physique et re ´adaptation, ho ˆpital d’instruction des arme ´es Laveran, BP 60149, 13884 Marseille cedex 13, France b Service de me ´decine interne et rhumatologie, ho ˆpital d’instruction des arme ´es Percy, 101, avenue Barbusse, 92140 Clamart, France c Service de me ´decine physique et re ´adaptation, ho ˆpital d’instruction des Arme ´es Percy, 101, avenue Barbusse, 92140 Clamart, France Received 8 February 2010; accepted 20 August 2010 Abstract Objective. – We report the case of a patient who developed paraplegia following a low lumbar epidural steroid injection. Alternative approaches to (or alternative means of) performing transforaminal injections should be considered, in order to avoid devastating neurological complications. Case report. – A 54-year-old man (who had undergone surgery 14 years earlier to cure an L5-S1 slipped disc with right S1 radiculopathy) presented with low back pain (which had begun 6 weeks previously) and left S1 radiculopathy. During a second infiltration of prednisolone acetate, the patient reported feeling a heat sensation in his legs and concomitantly developed facial flushing. Immediately after the injection, the patient developed complete, flaccid T7 ASIA A motor and sensory paraplegia. Three days later, T2 magnetic resonance imaging (MRI) of the spine revealed a spontaneous hypersignal in the conus medullaris and from T6 to T9, suggesting medullary ischemia. Recovery has been slow; after 4 months of treatment in a physical and rehabilitation medicine department, urinary and sensory disorders are still present (T7 ASIA D paraplegia). The patient can walk 200 m unaided. Three months later, the MRI data had not changed. Discussion. – This is a rare case report of paraplegia following low lumbar epidural infiltration via an interlaminar route. The mechanism is not clear. Most of authors suggest that the pathophysiological basis of this type of complication is ischemia caused by accidental interruption of the medullary blood supply. Direct damage to a medullary artery, arterial spasm or corticosteroid-induced occlusion due to undetected intra-arterial injection could result in medullary infarction. This serious incident should prompt us to consider how to avoid further problems in the future. It also raises the issue of providing patients with information on the risks inherent in this type of procedure. Conclusion. – Despite the rarity of this complication, patients should be made aware of its potential occurrence. In the case reported here, the functional prognosis is uncertain. # 2010 Elsevier Masson SAS. All rights reserved. Keywords: Epidural injection; Medullary ischemia; Corticosteroids; Low back pain; Sciatica; Complications; Degenerative disc disease Re ´sume ´ Objectif. – L’objectif est de rapporter un cas de paraple ´gie survenue au de ´cours d’une injection e ´pidurale lombaire basse de corticoı ¨des pour traiter une lomboradiculalgie S1 et de discuter les mesures a ` prendre pour e ´viter cet accident grave a ` partir de donne ´es de physiopathologie et d’une revue de la litte ´rature. Cas clinique. – Il s’agit d’un homme de 54 ans, ope ´re ´ 14 ans auparavant d’une cure de hernie discale L5-S1, pour une sciatique S1 droite, souffrant d’une lombosciatique gauche, depuis six semaines. Lors de la re ´alisation d’une seconde infiltration d’ace ´tate de prednisolone, il signale une sensation de chaleur des membres infe ´rieurs, concomitante d’un flush sur le visage. S’installe alors rapidement une paraple ´gie flasque T7 ASIA A. L’IRM me ´dullaire au troisie `me jour montre un hypersignal me ´dullaire spontane ´ en T2 au niveau du co ˆne et de T6 a ` T9, e ´voquant une mye ´lite ische ´mique. La re ´cupe ´ration est lente. Apre `s quatre mois de prise en charge en me ´decine physique et de re ´adaptation (MPR), le patient peut marcher sans aide 200 m. Ils persistent des troubles sensitifs et sphincte ´riens (paraple ´gie T7 ASIA D). Les images IRM sont inchange ´es a ` trois mois. Annals of Physical and Rehabilitation Medicine 53 (2010) 575–583 * Corresponding author. E-mail address: laurentthefenne@orange.fr (L. Thefenne). 1877-0657/$ – see front matter # 2010 Elsevier Masson SAS. All rights reserved. doi:10.1016/j.rehab.2010.08.029