Conus Medullaris Syndrome Days After A Single Epidural Steroid Injection

Abstract

Background: Epidural steroid injections (ESI) are commonly used in treatment of chronic lower back pain. Conus medullaris and cauda equina syndromes are rare complications of ESI. However, these typically occur after multiple injections within a few minutes to hours. Some reported cases are also transient, with patients completely regaining neurological function. We discuss a unique case of a patient developing conus medullaris syndrome over 24 hours after a single epidural steroid injection without resolution of symptoms.

Case Presentation: An 88-year-old male patient was admitted for lower extremity weakness the day after receiving an ESI for chronic lower back pain. MRI revealed T11-L5 subdural hematoma and a diagnosis of conus medullaris syndrome was made. After surgical decompression he regained some strength but permanent deficits remained.

Conclusion: Our case highlights the dangerous complications of epidural steroid injections and emphasizes the need for other treatment alternatives to alleviate CLBP.