Annals of Rehabilitation Medicine

Cervical Meningomyelitis After Lumbar Epidural Steroid Injection: Yujin Lee, Joon-Sung Kim, Ji Yeon Kim; Ann Rehabil Med 2015;39(3):504-507. Published online June 30, 2015; DOI: https://doi.org/10.5535/arm.2015.39.3.504

Abstract
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Epidural steroid injections (ESI) are a common treatment for back pain management. ESI-related complications have increased with the growing number of procedures. We report a case of cervical meningomyelitis followed by multiple lumbar ESI. A 60-year-old male with diabetes mellitus presented to our hospital with severe neck pain. He had a history of multiple lumbar injections from a local pain clinic. After admission, high fever and elevated inflammatory values were detected. L-spine magnetic resonance imaging (MRI) revealed hematoma in the S1 epidural space. Antibiotic treatment began under the diagnosis of a lumbar epidural abscess. Despite the treatment, he started to complain of weakness in both lower extremities. Three days later, the weakness progressed to both upper extremities. C-spine MRI revealed cervical leptomeningeal enhancement in the medulla oblongata and cervical spinal cord. Removal of the epidural abscess was performed, but there was no neurological improvement.

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Epidural Abscess and Vertebral Osteomyelitis Induced by Epidural Injection: A case report.: Lee, Ju Kang , Yim, Yoon Myung , Lim, Oh Kyung , Bae, Keun Hwan , Kim, Sung Hwan , Lee, Kwang Lae , Choi, Chung Hwan , Jeong, Jeom Sun; J Korean Acad Rehabil Med 2008;32(3):357-360.

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Epidural abscess and vertebral osteomyelitis induced by epidural injection is rare but one of the most serious complications. A 58-year old woman complained of aggrevating radicular pain to bilteral lower legs, tenderness on coccygeal area and claudication, after epidural injection for management of intractable sciatica. MRI and ultrasound revealed epidural abscess compressing dural sac at the level of L5-S1 vertebral body, sacrococcygeal abscess, and later S5- 1^stcoccyx osteomyelitis. We report epidural abscess and vertebral osteomyelitis induced by caudal epidural injection. (J Korean Acad Rehab Med 2008; 32: 357-360)

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Epidural Abscess and Pyogenic Arthritis of Knee Joint in One Family after Epidural Injection.: Seo, Jeong Hwan , Kim, Kwan min , Ko, Myoung Hwan; J Korean Acad Rehabil Med 2003;27(3):455-458.

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A mother-in-law and a daughter-in-law suffered chronic low back pain and they were injected epidural steroid on same day. Eleven days after injection, the daughter-in-law showed weakness of right lower extremity and lost filling sensation of bladder. Radiologic findings of Magnetic Resonance Imaging for lumbar spine revealed epidural abscess encompassing from L1 to sacral spine. After emergency surgical procedure and antibiotics therapy, the symptoms and the signs disappeared. Seven days after injection, the mother-in- law was diagnosed as pyogenic arthritis of right knee joint and then epidural abscess. Although the surgical procedure for right knee joint and antibiotics therapy were done, the epidural abscess didn't disappear. Moreover, surgical procedure for the epidural abscess couldn't be done due to septic condition, which was the cause of death. We report two cases of epidural abscess showing the importance of early management and serious end result. Prevention of these complication through extreme caution is needed. (J Korean Acad Rehab Med 2003; 27: 455-458)