Paraplegia following intracord injection during attempted epidural anesthesia under general anesthesia

Background and Objectives. A case of permanent paraplegia is reported following attempted epidural anesthesia for a total knee replacement in a 62-year-old woman with a history of lumbar laminectomy for a prolapsed intervertebral disc. Methods. Epidural puncture was attempted during general anesthesia and neuromuscular block. Results. After four unsuccessful attempts, an epidural catheter was inserted above the upper end of the laminectomy scar. Several episodes of arterial hypotension occurred intraoperative and postoperative. Operative blood loss was minimal, and no bone glue was used. The patient awoke paraparetic with a sensory level of anesthesia to T5 bilaterally. MRI revealed an air bubble in the cord at T10 and a region of increased T 2-weighted signal in the anterior aspect of the spinal cord between T4 and T5, consistent with infarction. Conclusion. Standards of management are discussed in relation to this case.