Digital subtraction angiography does not reliably prevent paraplegia associated with lumbar transforaminal epidural steroid injection

Abstract

Digital subtraction angiography (DSA) has been touted as a radiologic adjunct to minimize complications during interventional neuraxial procedures where it is imperative to identify vascular compromise. We present a case of instantaneous paraplegia following lumbar TFESI wherein a local anesthetic test dose, as well as DSA was used as adjuncts to fluoroscopy. An 80 year-old male with chronic L5 radiculopathic pain was evaluated at a University Pain Management Center. Two previous lumbar interlaminar epidural steroid injections provided transient pain relief, and decision was made to perform right-sided L5-S1 TFESI with a 5 inch, 22-gauge Quincke type spinal needle with a curved tip.