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Persistent cauda equina syndrome after caudal epidural injection under severe spinal stenosis: a case report

Authors Seo YT, Kong HH, Lee GJ, Bang HJ

Received 14 February 2017

Accepted for publication 17 May 2017

Published 12 June 2017 Volume 2017:10 Pages 1425—1429


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr E Alfonso Romero-Sandoval

Young Tak Seo,1 Hyun Ho Kong,1 Goo Joo Lee,1 Heui Je Bang1,2

1Department of Rehabilitation Medicine, Chungbuk National University Hospital, 2Department of Rehabilitation Medicine, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea

Abstract: Caudal epidural injection (CEI) is one of the most common treatments for low-back pain with sciatica. CEI rarely leads to neurologic complications. We report a case of persistent cauda equina syndrome after CEI. A 44-year-old male patient with severe L4 and L5 spinal stenosis underwent CEI for low-back pain and sciatica. The CEI solution consisted of bupivacaine, hyaluronidase, triamcinolone acetonide, and normal saline. He experienced motor weakness and sensory loss in both lower extremities and neurogenic bladder for more than 1 year after the procedure. His ankle dorsiflexors, big-toe extensors, and ankle plantar flexors on both sides were checked and categorized as motor-power Medical Research Council grade 0. His bilateral ankle-jerk reflection was absent. An electrophysiological study showed lumbosacral polyradiculopathy affecting both sides of the L5 and S1 nerve roots. A urodynamic study revealed hypoactive neurogenic bladder affecting both sacral roots.

Keywords: epidural injection, cauda equina syndrome, complications

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