Spinal Cord Injury Following Combined Spinal Epidural for Hip Arthroscopy  

A Case Study

Jeremy M. Huff, DO, FASA ● ZvonimirBebic, MD ● Marisa Sharkey, DO, FASA 

INTRODUCTION:

Spinal Cord Injury following neuraxial analgesia is rare yet presents patients and anesthesiologists with devastating consequences.

CASE INFORMATION:

A 16-year-old female presents for left hip arthroscopy/labral repair

Combined Spinal Epidural technique chosen

Anesthesiologist assesses L3-L4 level and performs CSE

No CSF or heme on Touhy placement

Positive CSF on spinal needle placement

No pain or paresthesia on injection of spinal dose

CASE PROGRESSION:

Uneventful intra-operative course

6 hours post-spinal patient c/o severe pain

Bilateral, non-dermatomal, lower extremity radicular pain

Allodynia from knees to toes and saddle anesthesia

Transferred to a tertiary children’s hospital post-op day #3

Diagnosis of spinal cord injury secondary to injection trauma

TREATMENT AND RESULTS:

Ketamine infusion, tramadol, pregabalin, and meloxicam

Adjunctive pain psychology and physical therapy

Pain and mobility improved

Discharged after 5 days to outpatient follow-up

Continue to follow >2 years

Weaned off medications

Continued bilateral dysesthesias and hyperalgesia

Retained and intact lower extremity motor function

IMAGING:

Lumbar X-ray:
- Entry point of epidural to be L1 (radiopaque bead at puncture site)

MRI Lumbar Spine:
- Termination of the conus at L1-2.
- Expansile lesion from the inferior mid to dorsal T11-L1

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