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Spinal Cord Infarction Following Therapeutic Computed Tomography-Guided Left L2 Nerve Root Injection

Somayaji, H S. MRCS*; Saifuddin, A MRCP, FRCR; Casey, A T.H. FRCS, SN; Briggs, T W.R. FRCS(Orth)*

doi: 10.1097/01.brs.0000153400.67526.07
Case Report

Study Design. Case report.

Objectives. To report a rare case of spinal cord infarction following therapeutic computed tomography-guided nerve root injection.

Summary of Background Data. Diagnostic and therapeutic image-guided nerve root injection is commonly performed in the management of low back pain and sciatica. The severe complication of spinal cord infarction has been reported in only 3 cases previously.

Methods. Retrospective review of case records and imaging.

Results. A 71-year-old woman presented with symptoms and signs of left L2 nerve root compression. She was managed with computed tomography-guided left L2 nerve root injection using bupivacaine and triamcinolone and developed immediate bilateral sensory loss and paraplegia. Magnetic resonance imaging demonstrated diffuse hyperintensity within the distal thoracic cord and conus on T2-weighted images, consistent with spinal cord infarction.

Conclusions. We report the fourth case of spinal cord infarction following nerve root injection. The severity of this complication warrants that it should be considered during patient consent for this procedure.

A 71-year-old woman developed spinal cord infarction following therapeutic computed tomography-guided left L2 nerve root injection, confirmed on magnetic resonance imaging. The severity of this complication warrants that it should be considered during patient consent for this procedure.

From the *Department of Orthopaedic Surgery, The Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, Middlesex, United Kingdom, †Department of Diagnostic Radiology, The Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, Middlesex, United Kingdom, and the ‡Department of Spinal Surgery, The Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, Middlesex, United Kingdom.

Acknowledgment date: January 19, 2004. First revision date: June 7, 2004. Acceptance date: June 11, 2004.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to A. Saifuddin, Consultant Radiologist, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex. HA7 4LP, United Kingdom; E-mail: Asaifuddin@aol.com

© 2005 Lippincott Williams & Wilkins, Inc.