Table 1.

Summary of the main findings according to the cases reported in the selected manuscripts.

Ref	Patients/Age, RF	Type of Anaesthesia and Injury	Possible Reasons/Aetiology/ Consequences	Treatments/Conducts/ Recommendations
[3]	1 CR -Morquio Syndrome + stenosis	L2–3 epidural + GA	Spinal cord infarction leading to complete paraplegia	Epidural discontinued and catheter removal
[8]	4 paediatric CRs 23 months old 12 yo, BMI of 27 12 yo 11 yo	Epidural + GA: L3-4 -ischemia or venous hypertension 2T12–L1 after 2 attempts -ischemia 3L3-4 (blood returned on the first attempt) -inflamed nerve roots 4T7-8 -vascular infarction	Flaccid paralysis, absent sensation MRI: ischemia or venous hypertension Paralysis, pain, absence of anal wink Urinary incontinence, numbness, and pelvic anaesthesia Pain, unresponsive and apnoeic, legs paralysis and paresis	Pharmacological and rehabilitation program with no further motor recovery Epidural catheter was removed, exploratory laminectomy Corticoids with full sensory and motor recovery Epidural discontinued, and catheter removed with permanent consequences
[9]	2 CRs 72 yo, hypertension 79 yo, no other RF found	L3-4 spinal -hematoma 2 L1-2 epidural -Hematoma	Complete paraplegia: one spinal cord compression (hematoma) and one subdural hematoma. A patient died in the decompression surgery	Drug discontinued and catheter removed + urgent decompression of the spinal canal
[10]	4 CRs 37 yo, alcohol abuse, trauma 28 yo, trauma 47 yo, trauma 49 yo, septicaemia	T8-9 epidural (10 days) -epidural abscess 2L3-4 epidural (7 days) + T7-8 epidural removed due purulent secretion -epidural abscess 3T7-8 epidural (17 days) -epidural abscess 4T9-10 epidural (12 days) -epidural abscess	Severe pain, complete paraplegia after rehabilitation Incomplete paraplegia, bladder paresis, disturbed bowel function Incomplete paraplegia, paresis, numbness Incomplete paraplegia with impaired bladder and bowel control	Same treatment for all cases: epidural abscess evacuation + antibiotic treatment + rehabilitation
[11]	1 CR -79 yo, diabetes	L2–L3 spinal -unilateral ischaemia	Severe subacute axonal sciatic damage and S1 root	Not reported
[12]	1 CR -40 yo, BMI of 16.6	T12-L1 epidural -epidural bloody collection	Permanent paraplegia following percutaneous nephrolithotomy	Monitoring to allow early detection of mismanagement and prevention of further neurologic injury
[21]	1 CR -28 yo, no RF found	L3-4 epidural -Spinal epidural hematoma with severe spinal cord stenosis	Pain, numbness, paraplegia, areflexia sensory loss and anal tone absent. Deep vein thrombosis	Surgical hematoma treatment and rehabilitation with functional recovery. Pharmacologic therapy to prevent further thrombosis
[23]	1 CR -66 yo, 87 kg, thrombosis	Spinal anaesthesia with first attempt believed to be at the L3–4	Intense pain, paralysis, sensory deficit. Autopsy: extensive haematomyelia	Subarachnoid injection withdrawn and moved to GA
[34]	1 CR -72 yo, systemic diseases (diabetes, hypertension…)	T11-12 epidural + GA -Spinal epidural hematoma	Fatigue in legs, loss of sensation, motor paralysis. CT + MRI showed a T9-11 spinal epidural hematoma	Emergency laminectomy and rehabilitation with symptoms slightly improved
[35]	1 CR -81 yo, hypertension	T9-10 epidural + GA -Intracord catheterization + anaesthetic injection	Numbness, weakness, bowel, and bladder incontinence. Sensory loss below T11 and permanent paraplegia	Little improvement after corticoid and rehabilitation
[36]	1 CR -34 yo, C3-4 trauma	C5-C6 epidural steroid block for pain control -posterolateral hematoma	Acute cervical myelopathy with pain, weakness	Hemilaminectomy with a near complete recovery
[37]	1 CR -61 yo, no RF found	T10-11 epidural + GA -Infarction from conus to thoracic cord	Confusion, pyrexia and tachycardia. Systemic inflammatory response syndrome. L3 flaccid paralysis, areflexia, analgesia and impaired sensation	Epidural catheter removed and rehabilitation
[38]	1 CR -69yo, recurrent pneumothoraces, angina	GA + several tentative of thoracic epidural -blood emerged from the needle	Spinal cord damage due to needle puncture and subsequent haematoma	Surgical dura repair with no improvement (paraplegic)
[39]	1 CR -75yo, no other RF found	3 attempts of L2-L3 spinal anaesthesia -subdural hematoma	Mental confusion, fever, permanent paraplegia	Moved to GA.Antibiotic + antinflammatory + hematoma decompression
[40]	3 CRs 64 yo 68 yo 28 yo, drug addict	L3-4 epidural -hematoma 2L3-4 epidural -epidural abscess 3.L1-2 epidural (pain) -Ischemia	Paraplegia due to epi-subdural hematoma Spastic paraplegia due epidural abscess Paracentral conus-epiconus ischemic lesion	Immediate laminectomy + rehabilitation Laminectomy + abscess removal Rehabilitation
[32]	1 CR -83yo, heart disease	L1-2 epidural (paraesthesia) -Epidural haematoma	Limited sensory and motor function, bowel and bladder incontinent. 10 days later: gangrenous stump and septic shock	Urgent spinal cord decompression + rehabilitation
[41]	1 CR -52 yo, 101 kg	L2-4 epidural (4 attempts) + GA -nerve root displacement due to extradural air	Prolonged paraesthesia and paresis	Corticoids. Patient with no pain or neurological symptoms
[42]	3 CRs 78 yo, no other RF found 30 yo, no RF found 29 yo, no RF found	L3-4 epidural -epidural haematoma 2L3-4 epidural (pain and confusion) -presumptive anterior spinal artery syndrome 3L3-4 epidural -anterior spinal artery syndrome	Motor and sensory loss Motor loss, loss of bladder and rectal sphincter function, numbness Pain and paralysis in the legs	Laminectomy with partial improvement Moved to GA + Neurologic consultations Neurologic consultations
[43]	1 CR -7 yo, referred patient	T12–L1 epidural + propofol sedationunexpected needle puncture	Myodynamia improved, but progressive pain persisted that was absent after second treatment	Analgesics and corticoids, then neurotropin. Patient reported gradual pain decrease
[44]	2 CRs 40 yo, no RF found 41 yo, no RF found	Spinal (acute shock sensation) Spinal (electric shock sensation) -possible ischemia, trauma, neurotoxicity, and haemorrhage	Total loss of sensation. MRI revealed a T2 hyperintensity in right paramedian hemiconus Complete numbness and weakness below hip region in the left lower limb	Corticoids with no benefit. Neurorehabilitation with slow improvement Neurorehabilitation with partial improvement
[45]	1 CR -21 yo, no RF found	L1-2 Spinal anaesthesia + T12–L1 interspace second attempt	Pain, persistent numbness, and weakness of her left lower limb with normal bladder and bowel sensations	Corticoids with gradual improvement
[46]	1 CR -82 yo, ASA III, hypocoagulation	L4-5 epidural + GA + enoxaparin -epidural hematoma	2nd postoperative day reduced sensation of the right and motor weakness of the left leg	Laminectomy with no improvement in neurologic function
[47]	2 CRs 73 yo, 30.9 of BMI, ASA IV 39 yo, no RF found	T4-5 epidural + GA -epidural hematoma 2T8-T9 epidural + GA -catheter malposition	MRI was performed only after paraplegia had developed the next day Paraesthesia, discomfort. Accidental re-start of epidural infusion led to coma, and respiratory arrest	Delayed hematoma evacuation with paraplegia Catheter position centrally in the spinal canal in CT
[33]	1 CR -73 yo, hypertension	Attempted T11-12 epidural for pain management -spinal hematoma	Motor deficit on right lower limb. MRI showed a direct spinal cord injury	Pharmacological treatment and laminectomy with slow recovery
[32]	1 CR -21 yo, no RF found	L3–4 spinal–epidural several attempts -Subdural hematoma	Left leg sensation and motor function completely recovered 3 h later	Hematoma absorption observation
[48]	1 CR -27 yo, no RF found	L4-5 spinal -severe adhesive arachnoiditis	Pain, communicating hydrocephalus and syringomyelia. Rapid, progressive paraplegia and sphincter dysfunction	Unsuccessful laminectomy, external drainage of the syrinx and intravenous steroids
[49]	1 CR -29 yo, no RF found	Combined spinal at L3-4 and epidural at L1-2 -adhesive arachnoiditis	Paraplegia, widespread syringomyelia, massive anterior arachnoid spinal cyst	Shunting of the cyst prevented symptoms progression. Numbness and motor weakness remained

Legend: Ref—reference, CR—case report, T—thoracic. L—lumbar, C—cervical, MRI—Magnetic Resonance Imaging, CT- Computed Tomography, GA—general anaesthesia, RF—risk factors, y—years old.