We present the case of a 60 yrs old male who, following a routine, uneventful, fluoroscopically guided L5/S1 facet joint rhizolysis and sacro-iliac joint (SIJ) injection developed an unexpected inability to stand or walk, a condition known as astasia-abasia. Initial concern had been that this neurological phenomenon was as a result of complications of his chronic pain intervention. Despite an essentially normal neurological examination and dedicated battery of neurological imaging and special testing, no cause was identified. Over a 7-day period of in-patient admission and physical rehabilitation symptoms resolved entirely. In the course of the workup for this episode, it was suggested that the phenomenon was the result of a side effect of dexamfetamine, an agent that had been prescribed for the patient by his neurologist for treatment of his narcolepsy. On the back of this episode, this treatment was discontinued by his neurologist following an outpatient consultation. Subsequent repeated SIJ injections were entirely uneventful and the patient experienced no further occurrences of this phenomenon.
References
[1]
Barnsley, L., Lord, S.M., Wallis, B.J. and Bogduk, N. (1995) The Prevalence of Chronic Cervical Zygapophysial Joint Pain after Whiplash. Spine, 20, 20-25.
[2]
Forst, S.L., Wheeler, M.T., Fortin, J.D. and Vilensky, J.A. (2006) The Sacroiliac Joint: Anatomy, Physiology and Clinical Significance. Pain Physician, 9, 61-67.
Wu, L., Tafti, D. and Varacallo, M. (2020) Sacroiliac Joint Injection. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK513245/
[5]
Vercueil, L. (2010 ) Astasie-Abasie: Causes psychogènes et non psychogènes (Astasia- Abasia: Psychogenic and Non-Psychogenic Causes). Revue Neurologique, 166, 221-228.
[6]
Han-Joon, K., Jee-Young, L. and Beom, S.J. (2010) Episodic Astasia-Abasia Associated with Hyperperfusion in the Subthalamic Region and Dorsal Brainstem. Neurology Asia, 15, 279-281.
[7]
Allegri, M., Montella, S., Salici, F., et al. (2016) Mechanisms of Low Back Pain: A Guide for Diagnosis and Therapy. F1000 Research, 5, 1530.
[8]
Velickovic, M. and Ballhause, T.M. (2016) Delayed Onset of a Spinal Epidural Hematoma after Facet Joint Injection. SAGE Open Medical Case Reports, 4, 1-5.
[9]
Kishner, S. and Schraga, E.D. (2017) Sacroiliac Joint Injection Technique. https://emedicine.medscape.com/article/103399-technique-
[10]
Lord, S.M., Barnsley, L., Wallis, B.J., McDonald, G.J. and Bogduk, N. (1996) Percutaneous Radio-Frequency Neurotomy for Chronic Cervical Zygapophyseal-Joint Pain. The New England Journal of Medicine, 335, 1721-1726.
[11]
Manchikanti, L., Malla, Y., Wargo, B.W., Cash, K.A., Pampati, V. and Fellows, B. (2012) Complications of Fluoroscopically Directed Facet Joint Nerve Blocks: A Prospective Evaluation of 7,500 Episodes with 43,000 Nerve Blocks. Pain Physician, 15, E143-E150.
[12]
Visser, L.H., Nijssen, P.G., Tijssen, C.C., Van Middendorp, J.J. and Schieving, J. (2013) Sciatica-Like Symptoms and the Sacroiliac Joint: Clinical Features and Differential Diagnosis. European Spine Journal, 22, 1657-1664.
