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Asian J Pain > Volume 3(2); 2017 > Article
Asian Journal of Pain 2017;3(2):36-38.
DOI: https://doi.org/10.35353/ajp.3.2.36    Published online October 30, 2017.
Non-surgical Treatment for Cauda Equina Syndrome after Lumbar Epidural Block
Jin-Woo Park, Junseok W Hur, Jang-Bo Lee, Jung-Yul Park
Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
Correspondence:  Jung-Yul Park, Tel: +82-2-920-6743, Fax: +82-2-929-0629, 
Email: jypark98@korea.ac.kr
Abstract
Lumbar epidural block is an important modality to manage degenerative spinal disease. Although the procedure related complication rate is low, cauda equina syndrome after epidural block rarely occurs. Herein we discuss a case of block related cauda equina syndrome without any thecal sac compressive lesion. A 50 years old woman have been suffered from bilateral buttock pain and claudication. She was diagnosed as L4/5 spinal stenosis and L5/S1 herniation of intervertebral disc (HIVD). Lumbar epidural block has been performed from other clinic, however, neurologic deterioration developed subsequently; bilateral lower extremities paresthesia/ weakness (G4), perineal numbness, and urinary incontinence. After transfer to our institute, we conducted magnetic resonance image (MRI) and confirmed there was no neural compressive lesion. After 3 days conservative treatments, perineal numbness gradually improved but paresthesia and both leg weakness remained. After one week, selective nerve root block (SNRB) was performed carefully and the patient showed improvement of symptoms by about 70%. Second SNRB was performed one week after first SNRB. After the second SNRB, the symptom improved enough to withstand. The patient still complained of mild bilateral both leg pain after discharge. Two months later, the patient underwent radiofrequency rhizotomy and the symptoms fully recovered. In case of cauda equina subsequent to block without any thecal sac compressive lesion, could be treated with non-operative modalities.
Key Words: Cauda equina; Epidural; Nerve block; Complication
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