Korean J Pain.  2015 Apr;28(2):148-152. 10.3344/kjp.2015.28.2.148.

Paraplegia Following Intercostal Nerve Neurolysis with Alcohol and Thoracic Epidural Injection in Lung Cancer Patient

• Kim BH
• No MY
• Han SJ
• Park CH
• Kim JH

• KMID: 2278280
• DOI: http://doi.org/10.3344/kjp.2015.28.2.148

Abstract

The goal of cancer treatment is generally pain reduction and function recovery. However, drug therapy does not treat pain adequately in approximately 43% of patients, and the latter may have to undergo a nerve block or neurolysis. In the case reported here, a 42-year-old female patient with lung cancer (adenocarcinoma) developed paraplegia after receiving T8-10 and 11th intercostal nerve neurolysis and T9-10 interlaminar epidural steroid injections. An MRI results revealed extensive swelling of the spinal cord between the T4 spinal cord and conus medullaris, and T5, 7-11, and L1 bone metastasis. Although steroid therapy was administered, the paraplegia did not improve.

Keyword

Intercostal nerve block; Lung cancer pain; Neurolysis; Paraplegia; Spinal cord infarction; Thoracic epidural injection

MeSH Terms

Adult
Conus Snail
Drug Therapy
Female
Humans
Injections, Epidural*
Intercostal Nerves*
Lung Neoplasms*
Magnetic Resonance Imaging
Neoplasm Metastasis
Nerve Block
Paraplegia*
Recovery of Function
Spinal Cord

Figure

• 

  Fig. 1 CT image following chemotherapy for adenocarcinoma of the lung. The CT image shows increased multiple pleuropulmonary metastasis in both hemithoraces, and a small amount of pericardial effusion.

• 

  Fig. 2 MRI images following the onset of paraplegia in this case. The CT spine image (A) shows a low-signal intensity, suggesting bone metastasis (chevron). A and B (T-L spine image) show a T2 high-signal intensity from the T4 level to the conus medullaris and a suspected cord infarction (arrow). The T2 weighted axial image (C) shows diffuse cord swelling, another suspected symptom of cord infarction (thick arrow).

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