Ann Rehabil Med.  2015 Aug;39(4):649-653. 10.5535/arm.2015.39.4.649.

Lumbar Epidural Steroid Injection for Painful Spasticity in Cervical Spinal Cord Injury: A Case Report

• Bang H
• Chun SM
• Park HW
• Bang MS
• Kim K

• KMID: 2148239
• DOI: http://doi.org/10.5535/arm.2015.39.4.649

Abstract

We report a case of a 53-year-old male with traumatic cervical spinal cord injury (SCI). He could not maintain a standing position because of painful spasticity in his lower limbs. A magnetic resonance imaging and electromyography indicated chronic lumbosacral radiculopathy, explaining his chronic low back pain before the injury. For diagnostic as well as therapeutic purposes, transforaminal epidural steroid injection (ESI) to the right L5 root was performed. After the intervention, the spasticity decreased and his ambulatory function improved. This case illustrates that lumbar radiculopathy concomitant with a cervical SCI can produce severe spasticity and it can be dramatically improved by ESI.

Keyword

Spinal cord injuries; Muscle spasticity; Radiculopathy

MeSH Terms

Electromyography
Humans
Low Back Pain
Lower Extremity
Magnetic Resonance Imaging
Male
Middle Aged
Muscle Spasticity*
Radiculopathy
Spinal Cord Injuries*
Spinal Cord*

Figure

• 

  Fig. 1 T2-weighted magnetic resonance imaging of the lumbar spine. (A-D) About 1 year before the injury. (A) Mid-sagittal view. (B) Axial view at L3/4 level. (C) Axial view at L4/5 level. (D) Axial view at L5/S1 level. (E-H) After the cord injury. (E) Mid-sagittal view. (F) Axial view at L3/4 level. (G) Axial view at L4/5 level. (H) Axial view at L5/S1 level.

• 

  Fig. 2 Right L5 transforaminal epidural steroid injection under fluoroscopic guidance. Injection level was determined by symptom provocation with 0.9% normal saline at L5 and S1 levels.

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