Major neurological sequelae of lumbar epidural anesthesia

Abstract

We here report the major permanent neurological complications that developed in three patients after epidural anesthesia. MR clearly showed that paraplegia, which arose one and nine days after anesthesia, was due to epi-subdural haematoma in the first case and epidural abscess in the second. The sudden left lower limb palsy in the third patient was caused by a paracentral ischemic lesion all along the conus-epiconus following a probable trauma of the cord during the insertion of the needle. Despite the fact that this was reported to have been performed at L1-L2, an erroneous introduction into the upper interspace must be postulated since the spinal cord of this patient terminated at mid-L1. Our report is useful insofar as it may remind anesthesiologists and neurologists to pay attention to the unusual complications of spinal anesthesia that may require urgent intervention.

Focal myelomalacia and syrinx formation after accidental intramedullary lidocaine injection during lumbar anesthesia: A report of 3 cases

“…Most previous reports of lumbar puncture related spinal cord injury have noted irreversible cord damage evidenced by persistent neurological deficits [6,14,17]. However, all 3 of our patients showed spontaneous motor recovery within 6 months and return of sensations in 12 months.…”

“…Furthermore, an LP done with the intention of giving spinal anesthesia will have an additional damaging effect on the cord by way of drug volume related pressure effect as well as chemical injury. These complications have occurred not only during performance of intended spinal anesthesia but even when the intention was just to introduce drug into the epidural space [14][15][16]. Complications such as arachnoiditis, infectious spondylodiscitis and development of arachnoid cyst have been observed to have developed gradually after the acute insult [17].…”

Monoplegia after Combined Spinal Epidural Anesthesia

“…[4] Direct trauma to the spinal cord during attempted epidural catheterization has been implicated as the possible cause of neurological complications. [5] In the case described by Bromage and Benumof, [6] an air bubble was identified within the cord of a patient who was left paraplegic after an attempted thoracic epidural using the loss of resistance to air technique to identify the epidural space. In our case postoperative MRI image showed a herniation at L5-S1 with compression to the thecal sac.…”

Epiduraler Abszeß nach lumbalem Epiduralkatheter zur Mobilisation des Kniegelenks

“…Auch in der neueren Literatur finden sich nur einige wenige Falldarstellungen [2,10,12,21], wobei es sich oft um Patienten mit Immunsuppression im weitesten Sinne handelt.…”