1436 - Transient Cauda Equina Syndrome Secondary to Lumbar Epidural Hematoma Following Epidural Steroid Injection

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

LV

Lauren Velasquez, n/a

Medical Student
Touro College of Osteopathic Medicine-Harlem, NY
Brooklyn, New York, United States
JK

Joseph Kastrenakes, DO

DO
NYU Langone
New York City, New York, United States
MC

Maanas Chiplunkar, DO

NYU PM&R Resident
NYU Langone Rusk Rehabilitation
New York, New York, United States

Co-Author(s)

AB

Amit Bansal, DO

Clinical Director, Inpatient Orthopedic Rehabilitation
NYU Langone Orthopedic Hospital
New York, New York, United States

Submitter(s)

LV

Lauren Velasquez

Touro College of Osteopathic Medicine-Harlem, NY
Brooklyn, New York, United States

Case Diagnosis: We present a case of a lumbar spine epidural hematoma caused by an epidural steroid injection (ESI) inciting compression of the spinal cord evolving to cauda equina syndrome, a rare complication of epidural steroid injections.

Case Description: An 86-year-old male with a past medical history of chronic low back pain on blood thinners presented to the emergency department complaining of lower extremity weakness and numbness 3 hours after receiving a bedside ESI without image guidance. He reported bilateral lower extremity weakness and S1 numbness in the feet and was noted to have 350mL of urinary retention with no urge to urinate. He had normal rectal tone and denied saddle anesthesia or fecal incontinence. MRI total spine showed an epidural hematoma at L2-L3 resulting in severe canal stenosis and cauda equina nerve root compression.

Discussions: ESIs are a widely used non-surgical pain modality for intractable chronic low back pain and recently have increased safety profile with improved techniques and an image-guided approach. Non-image guided ESIs have increased risk for complications, and the current literature is limited with a small number of case reports on significant risks, citing publication bias as a possible concern and receiving a status of “evidence of very low quality” in accordance with the GRADE system. Subsequently, transformation of an epidural hematoma to cauda equina syndrome is a serious complication rarely reported in the literature. The present case indicates the importance of utilizing image guidance to prevent catastrophic complications despite reported rarity of adverse events.

Conclusions: Although the procedure itself is relatively safe, a blind approach can have catastrophic complications. Literature supports that blind approach of ESI has clinical efficacy limited to short term pain relief and therefore should only be done in rare, resource-limited cases.