Epidural Spinal Injections Leads to Lower Limb Paralysis

This case involves a seventy-one-year-old female patient who underwent an epidural injection in the lumbar spine. Since the injection, the patient has experienced significant pain and weakness and she had great difficulty ambulating. According to the treating radiologist, there was evidence that the needle entered the spinal cord during the injection.

Question(s) For Expert Witness

1. What are risks associated with epidural spinal injections?

Expert Witness Response E-000312

When performed by a skilled, experienced clinician, in an appropriate setting and with carefully selected patients, the chance of significant complication from epidural steroid injections (ESIs) is remote. Nonetheless, similar to regional analgesia procedures, there are risks associated with ESIs. Cervical ESIs carry similar risks, with the apparent caveat that any damage to the spinal cord at the level of the cervical spine will often result in greater impairment than will damage at the lumbar levels. Additionally, it may precipitate respiratory arrest at higher cervical levels. There is the risk of spinal cord trauma if the operator performs direct injection into the spinal cord via an interlaminar approach. This risk is essentially absent at the lower lumbar spine, since the spinal cord terminates at the level of L2.