Lumbar epidural steroid injection for spasticity in paraplegic spinal cord injury: A case report

SAGE Open Medical Case Reports, 2024 · DOI: 10.1177/2050313X241258188 · Published: May 13, 2024

Spinal Cord Injury Neurology Pain Management

Simple Explanation

Spasticity is a common issue after spinal cord injury, potentially leading to joint stiffness if untreated. Common treatments include physical therapy, medications, and injections. This report describes a case where a man with lower extremity spasticity from an incomplete spinal cord injury experienced improved mobility after a lumbar epidural steroid injection (ESI). The case suggests that bedside ESI could be another option to consider for managing spasticity related to spinal cord injury.

Study Duration

Not specified

Participants

One 33-year-old male

Evidence Level

Level 4: Case Report

Key Findings

1
Epidural steroid injection led to a significant decrease in spasticity in a patient with traumatic paraplegic lumbar spinal cord injury.
2
Following the intervention, the patient could tolerate sit-to-stand transfers and ambulate with an exoskeleton device.
3
Repeat ESIs provided temporary relief from spasticity, radicular pain, and sleep disturbance, improving participation in gait training.

Research Summary

This case report presents the successful use of epidural steroid injection (ESI) to manage severe lower limb spasticity in a 33-year-old male with traumatic paraplegia following a knife assault. The patient experienced significant improvement in spasticity, pain reduction, and increased mobility, enabling participation in intensive inpatient rehabilitation, including sit-to-stand transfers and exoskeleton-assisted ambulation. The report suggests that bedside ESI can be a valuable intervention for managing paraplegic spasticity secondary to lumbar spinal cord injury in the inpatient rehabilitation setting, although the relief is temporary.

Practical Implications

Improved Rehabilitation Outcomes

ESI can improve functional outcomes in SCI patients with BLE spasticity.

Bedside Intervention

Consider bedside ESI for diagnostic and therapeutic benefit to SCI patients with intractable lower extremity spasticity in the IRF setting.

Adjunct Therapy Planning

Strategically plan adjunct therapies during the timeframe of maximum benefit from ESI to potentially improve long-term functional outcomes.

Study Limitations

1
Lack of long-term follow-up to determine if the multiple ESI therapies afforded any long-term benefit.
2
Thoracic SCI with lower extremity spasticity may present atypically and be more closely related to poor localization of pain.
3
The authors acknowledge the limitation of a single case report.

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