• Ziva Petrin, Ralph J Marino, Christina V Oleson, Jeremy I Simon, and Zachary L McCormick.
• From the Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah (ZP, ZLM); Department of Rehabilitation Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia Pennsylvania (RJM); Department of Physical Medicine and Rehabilitation, Case Western Reserve University School of Medicine, Cleveland, Ohio (CVO); and Division of Physical Medicine and Rehabilitation, The Rothman Institute of Thomas Jefferson University, Philadelphia, Pennsylvania (JIS).
• Am J Phys Med Rehabil. 2020 Sep 1; 99 (9): e107-e110.

AbstractParaplegia after interlaminar epidural steroid injection is a rare event and has typically been described after epidural hematoma or direct spinal cord injury. We present a case of an 87-yr-old man who experienced transient lower limb weakness after a lumbar interlaminar epidural steroid injection due to an alternative cause, congestive myelopathy related to an underlying vascular malformation, namely, a spinal dural arteriovenous fistula. This is a poorly recognized and potentially treatable cause of progressive myelopathy. We present this case and review the literature on paraplegia after epidural steroid injection due to spinal dural arteriovenous fistula. Notably, this case of paralysis occurred in association with the lowest volume of epidural injectate reported in the literature to date (4 ml); importantly, this volume is consistent with the current clinical practice guideline standards for the safe performance of interlaminar epidural steroid injections. Physicians should be aware of this potential complication of epidural steroid injection and remain vigilant for the possibility after a procedure, even when performed according to current practice standards.

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