Bacterial meningitis and cauda equina syndrome after epidural steroid injections

Abstract

Purpose: To describe a rare adverse outcome resulting from lumbar epidural steroid injections for the treatment of chronic lower back pain. Clinical features: We report a case of Staphylococcus aureus meningitis and cauda equina syndrome following a series of epidural steroid injections for chronic back pain. Although rare, bacterial meningitis following epidural analgesia has been reported; but epidural steroid injections have not been associated with either bacterial meningitis or cauda equina syndrome. The causal relationship between epidural steroid injections, bacterial meningitis, and caudal equina syndrome is discussed. Conclusion: A thorough pre-procedure assessment with attention to the neurologic examination and signs/symptoms of infection is essential.