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Acute Motor Weakness of Opposite Lower Extremity after Percutaneous Epidural Neuroplasty

  • Received : 2014.11.19
  • Accepted : 2015.01.22
  • Published : 2015.04.01

Abstract

Recently, percutaneous epidural neuroplasty has become widely used to treat radicular pain caused by spinal stenosis or a herniated intervertebral disc. A 19-year-old female patient suffering from left radicular pain caused by an L4-L5 intervertebral disc herniation underwent percutaneous epidural neuroplasty of the left L5 nerve root using a Racz catheter. After the procedure, the patient complained of acute motor weakness in the right lower leg, on the opposite site to where the neuroplasty was conducted. Emergency surgery was performed, and swelling of the right L5 nerve root was discovered. The patient recovered her motor and sensory functions immediately after the surgery. Theoretically, the injection of a large volume of fluid in a patient with severe spinal stenosis during epidural neuroplasty can increase the pressure on the opposite side of the epidural space, which may cause injury of the opposite nerve by barotrauma from a closed compartment. Practitioners should be aware of this potential complication.

Keywords

References

  1. Racz GB, Holubec JT. Lysis of adhesions in the epidural space. In: Techniques of neurolysis. Edited by Racz GB. Boston (MA), Kluwer Academic Publishers. 1989, pp 57-72.
  2. Epter RS, Helm S 2nd, Hayek SM, Benyamin RM, Smith HS, Abdi S. Systematic review of percutaneous adhesiolysis and management of chronic low back pain in post lumbar surgery syndrome. Pain Physician 2009; 12: 361-78.
  3. Belozer M, Wang G. Epidural adhesiolysis for the treatment of back pain. Health Technol Assess 2004; 5: 1-19.
  4. Helm Ii S, Benyamin RM, Chopra P, Deer TR, Justiz R. Percutaneous adhesiolysis in the management of chronic low back pain in post lumbar surgery syndrome and spinal stenosis: a systematic review. Pain Physician 2012; 15: E435-62.
  5. Lee F, Jamison DE, Hurley RW, Cohen SP. Epidural lysis of adhesions. Korean J Pain 2014; 27: 3-15. https://doi.org/10.3344/kjp.2014.27.1.3
  6. Manchikanti L, Malla Y, Wargo BW, Cash KA, Pampati V, Fellows B. A prospective evaluation of complications of 10,000 fluoroscopically directed epidural injections. Pain Physician 2012; 15: 131-40.
  7. Ho KY, Manghnani P. Acute monoplegia after lysis of epidural adhesions: a case report. Pain Pract 2008; 8: 404-7. https://doi.org/10.1111/j.1533-2500.2008.00229.x
  8. Bromage PR. Subarachnoid catheters and the cauda equina syndrome: hypotheses in need of trial. Anesthesiology 1994; 80: 711-2. https://doi.org/10.1097/00000542-199403000-00049
  9. Rocco AG, Philip JH, Boas RA, Scott D. Epidural space as a Starling resistor and elevation of inflow resistance in a diseased epidural space. Reg Anesth 1997; 22: 167-77. https://doi.org/10.1016/S1098-7339(06)80037-4
  10. Chaudhari LS, Kop BR, Dhruva AJ. Paraplegia and epidural analgesia. Anaesthesia 1978; 33: 722-5.