Lumbar Epidural Steroid Injection for Painful Spasticity in Cervical Spinal Cord Injury: A Case Report

Ann Rehabil Med, 2015 · DOI: 10.5535/arm.2015.39.4.649 · Published: August 19, 2015

Spinal Cord Injury Pain Management Rehabilitation

Simple Explanation

Spasticity, a common issue after spinal cord injury (SCI), can cause problems like movement difficulties and pain. While treatments exist, finding the exact cause of spasticity can be challenging. This case report explores a patient with cervical SCI whose lower limb spasticity was significantly improved after receiving a lumbar epidural steroid injection (ESI), typically used for lower back pain. The underlying thought is that radiculopathy (nerve root issues) in the lower back can aggravate spasticity in SCI patients, even if the primary injury is in the neck. Addressing the radiculopathy with ESI can alleviate the spasticity.

Study Duration

Not specified

Participants

One 53-year-old male with traumatic cervical spinal cord injury

Evidence Level

Level IV, Case Report

Key Findings

1
A patient with cervical SCI experienced significant reduction in lower limb spasticity and pain after lumbar ESI.
2
The patient's ambulatory function improved, allowing him to walk further and improve his sleep quality.
3
The case suggests that lumbosacral radiculopathy can be a trigger for painful spasticity in cervical SCI patients.

Research Summary

This case report describes a 53-year-old male with cervical spinal cord injury (SCI) who suffered from severe pain and spasticity in his lower limbs, hindering his ability to stand and walk. Following a lumbar transforaminal epidural steroid injection (ESI) targeting the right L5 nerve root, the patient experienced a significant reduction in spasticity and pain, leading to improved ambulatory function. The findings suggest that lumbosacral radiculopathy can be an aggravating factor for spasticity in cervical SCI patients, and ESI may be a beneficial intervention in such cases.

Practical Implications

Diagnostic Consideration

Consider lumbosacral radiculopathy as a potential cause of intractable lower extremity spasticity in patients with cervical SCI.

Therapeutic Intervention

Epidural steroid injection (ESI) can be selected as a diagnostic and therapeutic approach for managing painful spasticity related to radiculopathy in cervical SCI patients.

Improved Rehabilitation

Alleviating spasticity through ESI can facilitate more effective gait training and improve overall functional outcomes in SCI patients.

Study Limitations

1
Single case report limits generalizability.
2
Causal relationship between radiculopathy and spasticity not definitively proven.
3
Lack of a control group to compare outcomes.

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