Mr H underwent bilateral lumbar facet joint injections at the L3/4, L4/5 and L5/S1 levels using triamcinolone acetonide combined with 0.75% bupivacaine.
Within days, he reported severe bilateral lower limb pain and weakness, worsening lower back pain with marked paraspinal tenderness and increased opioid use, resulting in constipation.
On examination, allodynia, hyperalgesia and reduced right lower limb motor power was identified. The presentation raised concerns for serious underlying pathology.
