Abstract Details

Title Conus Medullaris Syndrome and Cauda Equina Syndrome after Lumbar Epidural Steroid Injection: A Systematic Review of Literature

Topic Pain

Presentation(s) S24 - Pain and Palliative Care: Targeted Therapy in Chronic Pain Disorders (4:32 PM-4:40 PM)

Poster/Presentation
Number 004

Objective To describe the characteristics of CMS/CES after ESI through a systematic review.

Background Epidural steroid injections (ESI) are used to treat lower back pain. Conus medullaris syndrome (CMS) and cauda equina syndrome (CES) are rare complications of the procedure.

Design/Methods A systematic review of PubMed, Embase, Cochrane, Scopus, and Google Scholar was conducted. 453 articles were selected for review. Inclusion criteria consisted of adult patients, epidural injections, and treatment of lower back pain. Patients with prior histories of spinal surgery, lower extremity paralysis, or bowel/bladder dysfunction were excluded.

Results After full-text screening, 22 articles were included. 22 cases were reported, with a mean age of 59.48 years (range 30-83) and 65% males. Most cases presented within a few minutes of ESI (45%), followed by onset 4 hours after ESI (36%), and the minority (14%) presenting over 24 hours after ESI. A majority of patients (54%) did not regain full neurological function, but time to onset of symptoms did not predict recovery (OR 0.6, 95% CI: 0.10-3.72). The most common mechanism of insult was cord ischemia (45%). Other etiologies of CMS/CES were hematoma, hemorrhage within a pre-existing spinal mass, spinal dural arteriovenous fistula, and epidural abscess; each present in 9% of patients. The mechanism of injury was not predictive of clinical recovery (OR 0.10, 95% CI: 0.01-1.11). However, when comparing patients with cord ischemia to patients with other etiologies, the difference in recovery was statistically significant (p = 0.040). Having multiple ESI did not increase the likelihood of developing CMS/CES (OR 0.5, 95% CI: 0.09-3.31).

Conclusions While CMS/CES as complications of ESI are rare, the majority of these patients do not achieve resolution of symptoms. Cord ischemia is the most common mechanism. The etiology of deficits, time of symptom onset, and the number of ESI do not impact clinical course.

Authors/Disclosures
Aimen Vanood, MD (Mayo Clinic Arizona) PRESENTER	Dr. Vanood has nothing to disclose.
	No disclosure on file
Katherine E. Wheeler	Miss Wheeler has nothing to disclose.
Gustavo A. Patino, MD, PhD (Western Michigan University Homer Stryker MD School of Medicine)	Dr. Patino has received publishing royalties from a publication relating to health care. Dr. Patino has received personal compensation in the range of $0-$499 for serving as a project mentor with Manning Publications.

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