Neurological injury after transforaminal epidural steroid injection: Rare complication or natural progressive neurological deficit?

Abstract

Transforaminal epidural corticosteroid injections (TFESI) are widely used for subacute lumbosacral radicular pain and are typically applied during the time frame of potential evolution to neurological complications. We present a case report of a patient with lumbar spinal canal stenosis who developed a cauda equina syndrome (CES) after lumbar TFESI requiring emergency decompression. Lumbosacral radicular pain usually has a positive evolution. Some pitfalls may mask progressive neurological deterioration and obscure the causal relation with an epidural corticosteroid injection. An intake consultation with the patient’s informed consent and information on red flags before the procedure is required. If neurological deterioration occurs after a lumbar TFESI, it is sometimes impossible to discriminate the added effect of TFESI to the ongoing progression of neurological deficit. In patients with spinal canal stenosis, the injected volume should preferentially be small to minimize a possible increase in epidural pressure.