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A fluoroscopy-guided lumbar spine injection procedure may be complicated by immediate paralysis. Twelve cases (five recent and seven published) that occurred between 2002 and 2008 were reviewed (history of lumbar surgery, route of injection, image-guidance, injection of contrast, type of steroid, level of paraplegia, MR imaging features). MRI showed cord ischemia from arterial origin. The high number of patients with prior lumbar spine surgery suggests that the presence of scar tissue could increase the risk of paraplegia. A transforaminal approach was used in all patients without history of lumbar surgery while transforaminal, interlaminar and juxta-zygapophyseal approaches were used in patients with prior lumbar surgery. The high number of cases in France could be explained by the exclusive use of prednisolone acetate which has a higher rate of macro-aggregate formation that could lead to embolization in medullary arteries.
Service de Radiologie Ostéo-articulaire, Hôpital Lariboisière, AP-HP, 2 rue Ambroise Paré, 75010 Paris, France.
This article was published in the following journal.
Name: Journal de radiologie
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The injection of drugs, most often analgesics, into the spinal canal without puncturing the dura mater.
The injection of autologous blood into the epidural space either as a prophylactic treatment immediately following an epidural puncture or for treatment of headache as a result of an epidural puncture.
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A rare epidural hematoma in the spinal epidural space, usually due to a vascular malformation (CENTRAL NERVOUS SYSTEM VASCULAR MALFORMATIONS) or TRAUMA. Spontaneous spinal epidural hematoma is a neurologic emergency due to a rapidly evolving compressive MYELOPATHY.
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