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2017 ; 8
(ä): 60
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Neurological complications of lumbar and cervical dural punctures with a focus on
epidural injections
#MMPMID28540126
Epstein NE
Surg Neurol Int
2017[]; 8
(ä): 60
PMID28540126
show ga
BACKGROUND: Various types of lumbar dural punctures may contribute to
neurological injury. The etiologies of dural injury include; inadvertent dural
punctures due to epidurals placed for labor anesthesia, epidural steroid
injections (ESI/transforaminal TESI; approximately 9 million ESI performed in the
US per year), deliberate placement of intradural pain devices, and spontaneous
cerebrospinal fluid (CSF) fistulas. Resulting neurological complications may
include; spinal headaches/intracranial hypotension, subdural hematomas, and 6(th)
nerve cranial palsies. Furthermore, uniquely in the cervical spine, inadvertent
cervical dural punctures attributed to cervcial ESI (CESI) may lead to
intramedullary spinal cord injuries (e.g. resulting in monoparesis to
quadriplegia) or spinal cord strokes due to intravascular/vertebral artery
injections. METHODS/RESULTS: In 8 studies, inadvertent lumbar dural punctures
contributed to intracranial hypotension, subdural hematomas, and double
vision/6(th) cranial nerve palsies. In 5 of the 6 studies, inadvertent dural
punctures occurring during CESI were responsible for intramedullary spinal cord
injuries, or direct intravascular/vertebral injections resulting in
monoplegia/quadriplegia. CONCLUSIONS: Inadvertent lumbar dural punctures led to
multiple neurological complications including intracranial hypotension, subdural
hematomas, and double vision/6(th) cranial nerve palsies. Uniquely, inadvertent
cervical dural punctures solely due to CESI directly resulted in intramedullary
spinal cord injuries or cord stroked and monoplegia/quadriplegia attributed to
intravascular/vertebral artery injections. The potential neurological
risks/complications/adverse events attributed to lumbar and cervical ESI must be
taken into account before spine surgeons and others order these procedures.