Spinal cord injury complicating a thoracolumbar selective nerve root block in a deformed spine: Neurological and functional outcome

Abstract

Study design: A case report of a female patient who sustained injury to the thoracic spinal cord as a direct result of thoracolumbar selective nerve root block. Objective: To raise the awareness that selective nerve root infiltration, a very common procedure in a pre-existing deformity, may cause injury to the spinal cord with dire consequences, albeit rarely. Case report: An 82-year-old retired nurse (who had sustained osteoporotic compression fractures of the T12 vertebra) who presented with a 2-year history of continuous low back pain following a fall into a pothole. Immediately after image-guided, transforaminal infiltration of left side T12 root the patient developed sudden onset of complete motor and sensory T10 level flaccid paraplegia. No abnormality was noted on T2 magnetic resonance imaging (MRI) of the spine on the same day. Eleven days later, T2 MRI of the spine with gadolinium contrast revealed an increased fluid signal in conus medullaris. At 2-year follow-up, the neurological improvement has been good (L2 level American Spinal Injury Association/International Spinal Cord Society (ASIA/ISCoS) neurological standard scale (AIS) D paraplegia), urinary and sensory disorders are still present. Conclusion: Injury to the spinal cord is known to occur in interventions such as epidural steroid infiltrations. Over time, pain management in relation to the new and emerging interventions on spine have changed. What might not be appreciated is the awareness that such interventions may cause injury to the spinal cord with serious consequences. Despite potential occurrence, in the case reported here, the neurological and functional prognosis is good with an expert, early and appropriate management in a spinal injuries centre.