Domínguez-Gasca LG, Sandoval-Larios CG, López-Alcalá LA, Hasslacher-Arellano JF, Mora-Constantino J, Domínguez-Carrillo LG

Language: Spanish
References: 10
Page: 141-145
PDF size: 161.59 Kb.

ABSTRACT

A case of a 27-year-old woman is described who suffered neurological damage to the conus medullaris following spinal-epidural anaesthesia. She experienced bilateral calf pain during the insertion of the needle introduced at the L1-L2 interspace; the needle was withdrawn and a catheter was placed; she received pharmacological sedation. Three hours post-surgery, she presented bilateral burning pain in legs, without urinary symptoms, but with bilateral calf muscles severe paresis, being the right side more affected at the levels of L4-S1. Magnetic resonance imaging showed high signal in conus. She was treated with steroids and early rehabilitation during nine months. She recovered her muscular strength in all involved muscles, but she retains mild paresis of the right soleus and gastrocnemius and mild paresthesia of the three outer toes of the left foot. She has a normal gait, normal jogging, but not running. The Tuffier’s line is an unreliable method of identifying the lumbar interspaces, and anaesthetists commonly select a space that is one or more segments higher than they assume; because of these sources of error, anaesthetists need to relearn the rule that a spinal needle should not be inserted above L3 level.

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