非影像学引导下硬膜外类固醇注射的并发症髓圆锥和马尾综合征:两例综合跨学科随访报告。

IF 2.2 3区 医学 Q3 CLINICAL NEUROLOGY
Oliver Gross, Kerstin Schweyer, Benjamin Fritz, Thomas M Kessler, Martin Schubert, Armin Curt, Carl M Zipser
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引用次数: 0

摘要

简介:硬膜外类固醇注射(ESI)通常在门诊用于缓解腰骶神经根痛,即坐骨神经痛。神经系统和神经泌尿系统的不良事件是罕见的,但发生时是毁灭性的。这导致了美国食品和药物管理局对脊柱使用皮质类固醇的警告。缺乏对并发症的原因和数量的评论。病例介绍:来自我们第三脊柱中心的两例患者在非我们机构附属的二级护理机构接受ESI后持续出现髓圆锥和马尾综合征。两名患者在注射前均接受ESI治疗无坐骨神经痛的慢性腰痛和任何报告的神经损伤。在病例1 (F, 72岁)和病例2 (F, 72岁)中,ESI在没有成像指导和介入前腰椎MRI的情况下进行。我们通过彻底的神经学检查、全面的神经影像学、神经生理学和神经泌尿学评估对两例患者进行了评估。病例1为马尾综合征,腰椎MRI诊断蛛网膜炎。病例2为脊髓圆锥综合征,可能与意外硬脑膜穿刺有关。腰骶感觉障碍症状部分恢复,运动症状恢复,但神经源性下尿路和肠道功能障碍持续存在。一名患者仍需要间歇性自我导尿,而另一名患者在2年随访时出现肠功能障碍。讨论:虽然ESI的神经系统并发症很少报道,但它们可能与严重的长期损伤有关。需要全面的诊断工作来辨别潜在的潜在病理机制和量化神经损伤负荷。需要神经泌尿学诊断来发现膀胱-肠功能障碍,采取适当的治疗措施并预防继发性并发症。我们提倡ESI影像学指导,以减少神经系统并发症的发生率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Conus medullaris and cauda equina syndrome as complications of non-imaging guided epidural steroid injection: two case reports with comprehensive interdisciplinary work-up.

Conus medullaris and cauda equina syndrome as complications of non-imaging guided epidural steroid injection: two case reports with comprehensive interdisciplinary work-up.

Conus medullaris and cauda equina syndrome as complications of non-imaging guided epidural steroid injection: two case reports with comprehensive interdisciplinary work-up.

Conus medullaris and cauda equina syndrome as complications of non-imaging guided epidural steroid injection: two case reports with comprehensive interdisciplinary work-up.

Introduction: Epidural steroid injection (ESI) is commonly performed in the outpatient setting for relieving lumbosacral radicular pain, i.e., sciatica. Neurological and neuro-urological adverse events are rare but devastating when occurring. This led to a warning of the U.S. Food and Drug Administration about the use of corticosteroids in the spine. Reviews on causes and numbers of complications are lacking.

Case presentation: Two cases from our tertiary spine center who sustained conus medullaris and cauda equina syndrome following ESI in a secondary care setting not affiliated with our institution. Both patients received ESI for the treatment of chronic lower back pain without sciatica and any reported neurological impairment prior to the injection. In both Case 1 (F, 72yrs) and Case 2 (F, 72yrs), ESI was administered without imaging-guidance and without pre-interventional lumbar MRI. We assessed both patients by thorough neurological examination, comprehensive neuroimaging, neurophysiology, and neuro-urological assessments. Case 1 had cauda equina syndrome, arachnoiditis was diagnosed from lumbar MRI. Case 2 had conus medullaris syndrome probably related to a reported accidental dura puncture. Symptoms of lumbosacral sensory impairment partly recovered, motor symptoms recovered, but neurogenic lower urinary tract and bowel dysfunction persisted. One patient still requires intermittent self-catheterization, while the other patient suffers from bowel dysfunction at 2-yr follow up.

Discussion: Although neurological complications from ESI are rarely reported they can be associated with serious long-term impairments. Comprehensive diagnostic work-up is required to discern potential underlying pathomechanisms and to quantify neural damage load. Neuro-urological diagnostics is required to reveal bladder-bowel dysfunction, install proper management and to prevent secondary complications. We advocate imaging-guidance in ESI to reduce the rate of neurological complications.

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来源期刊
BMC Neurology
BMC Neurology 医学-临床神经学
CiteScore
4.20
自引率
0.00%
发文量
428
审稿时长
3-8 weeks
期刊介绍: BMC Neurology is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of neurological disorders, as well as related molecular genetics, pathophysiology, and epidemiology.
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