Caudal epidural
steroid injection is a very common intervention in treatment of
low back pain and
sciatica symptoms. Although extensively used, it is not devoid of complications. A few reports of chemical and infective
arachnoiditis exist following lumbar epidural anaesthesia, but none following a caudal epidural
steroid injection.We report a case of
arachnoiditis following caudal epidural
steroid injections for lumbar
radiculopathy. The patient presented with contralateral
sciatica, worsening
low back pain and
urinary retention few days following the injection, followed by worsening motor functions in L4/L5/S1 myotomes with resultant dense
foot drop.
Gadolinium-enhanced magnetic resonance imaging suggested infective
arachnoiditis with diffuse enhancement and clumping of the nerve roots within the lumbar and sacral thecal sac. As the number of
injections in the management of
back pain and lumbo-sacral radicular
pain is increasing annually, it is imperative to have a thorough understanding of this potentially dangerous complication and educate the patients appropriately.