게시판
| 21KS-003 |
Acute motor weakness of lower extremity after a novel ballon inflatable catheter for percutaneous epidural adhesiolysis
Department of Anesthesiology and Pain Medicine, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
Introduction
Percutaneous epidural adhesiolysis (PEA) and decompression with a newly developed inflatable balloon catheter are being increasingly performed to treat radicular pain caused by spinal stenosis, herniated intervertebral disc (HIVD), or failed back surgery (1,2). we report a case of a patient who suffered from monoplegia of the right-side lower extremity following PEA and decompression with a newly developed inflatable balloon catheter on the right side and recovered after conservative treatment.
Case report
A 64-year-old patient visited the pain clinic for lower back pain and right buttock pain radiating to the leg two months prior. Lumbar MRI revealed central stenosis at the L5/S1. She was treated with medication and five times epidural steroid injections. Because the pain was not relieved, we decided to treat her with PEA with inflatable balloon.
After sterile preparation for the procedure, a caudal epidurogram showed a filling defect from the central epidural space at the L3-L4, L5-S1. We performed mechanical adhesiolysis and decompression using a ballooning catheter (Fig. 1). Before removal of the catheter, 1,500 units of hyaluronidase in 10 ml ,10 ml of a mixture of 0.1% ropivacaine and 20 mg triamcinolone was administered via the catheter. After 2 h, the patient complained of sudden motor weakness in the right lower limb. An urgent MRI was performed, but no epidural hematoma or suspicious lesions were observed (Fig. 2).
After consulting with the neurosurgeons, 1000 mg of methylprednisolone was injected intravenously daily for 3 days and 150 mg pregabalin, 75 mg tramadol HCl, and 650 mg acetaminophen were prescribed. Motor weakness and paresthesia improved gradually over time, and the patient was discharged and followed up. At the follow-up visit after 3 weeks, there were no signs of motor or sensory abnormalities.
Conclusion
After PEA, direct nerve damage or volume-induced nerve compression caused by the injected drug may occur, and even motor weakness may occur. In addition, in the case of severe extraforaminal and spinal stenosisis, careful consideration of the dosage and procedure time is required.
References
1. Epidural neuroplasty/epidural adhesiolysis. Anesthesia and Pain Medicine 2016;11(1):14-22. Published online: January 31, 2016.
Percutaneous epidural adhesiolysis (PEA) and decompression with a newly developed inflatable balloon catheter are being increasingly performed to treat radicular pain caused by spinal stenosis, herniated intervertebral disc (HIVD), or failed back surgery (1,2). we report a case of a patient who suffered from monoplegia of the right-side lower extremity following PEA and decompression with a newly developed inflatable balloon catheter on the right side and recovered after conservative treatment.
Case report
A 64-year-old patient visited the pain clinic for lower back pain and right buttock pain radiating to the leg two months prior. Lumbar MRI revealed central stenosis at the L5/S1. She was treated with medication and five times epidural steroid injections. Because the pain was not relieved, we decided to treat her with PEA with inflatable balloon.
After sterile preparation for the procedure, a caudal epidurogram showed a filling defect from the central epidural space at the L3-L4, L5-S1. We performed mechanical adhesiolysis and decompression using a ballooning catheter (Fig. 1). Before removal of the catheter, 1,500 units of hyaluronidase in 10 ml ,10 ml of a mixture of 0.1% ropivacaine and 20 mg triamcinolone was administered via the catheter. After 2 h, the patient complained of sudden motor weakness in the right lower limb. An urgent MRI was performed, but no epidural hematoma or suspicious lesions were observed (Fig. 2).
After consulting with the neurosurgeons, 1000 mg of methylprednisolone was injected intravenously daily for 3 days and 150 mg pregabalin, 75 mg tramadol HCl, and 650 mg acetaminophen were prescribed. Motor weakness and paresthesia improved gradually over time, and the patient was discharged and followed up. At the follow-up visit after 3 weeks, there were no signs of motor or sensory abnormalities.
Conclusion
After PEA, direct nerve damage or volume-induced nerve compression caused by the injected drug may occur, and even motor weakness may occur. In addition, in the case of severe extraforaminal and spinal stenosisis, careful consideration of the dosage and procedure time is required.
References
1. Epidural neuroplasty/epidural adhesiolysis. Anesthesia and Pain Medicine 2016;11(1):14-22. Published online: January 31, 2016.