Iatrogenic cervical spinal cord injury after interlaminar cervical epidural injection

Interventional Pain Medicine, 2023 · DOI: https://doi.org/10.1016/j.inpm.2023.100288 · Published: November 2, 2023

Simple Explanation

Cervical epidural injections (CEI) are used to treat neck pain, but this case report describes a severe complication: spinal cord injury. The patient had a history of neck issues and prior surgery, potentially increasing the risk. After the injection, the patient experienced weakness and abnormal sensations, and an MRI revealed damage to the spinal cord. This highlights the importance of careful technique and awareness of patient-specific risks. The authors suggest that pre-operative imaging, knowledge of spinal anatomy, and careful patient monitoring are crucial to prevent such complications. They also recommend considering alternative treatments for axial neck pain.

Study Duration

Not specified

Participants

One patient

Evidence Level

Case Report

Key Findings

1
A patient developed a spinal cord injury (SCI) after an interlaminar cervical epidural injection (CEI).
2
MRI showed an increased T2 signal and decreased T1 signal in the spinal cord extending from C3-T3, indicating spinal cord damage.
3
Factors such as prior ACDF, cervicovertebral ligament anomalies, repetitive microtrauma from serial CEI’s, and epidural space compromise may have contributed to the injury.

Research Summary

This case report describes a patient who suffered a spinal cord injury following a cervical epidural injection. The patient had a history of prior cervical surgery and received the injection for uncontrolled cervicalgia. The authors discuss potential contributing factors, including altered spinal anatomy due to previous surgery, repetitive injections, and a narrow epidural space. They emphasize the need for careful patient evaluation and technique. The report concludes with recommendations for minimizing the risk of such complications, including pre-procedural imaging, limiting sedation, and considering alternative treatments when appropriate.

Practical Implications

Enhanced Pre-Procedural Assessment

Meticulous review of patient history, including prior surgeries and imaging, to identify potential risk factors.

Cautious Injection Technique

Employing precise technique with consideration of altered anatomy, avoiding over-sedation, and limiting injectate volume.

Alternative Treatment Considerations

Exploring alternative treatment options like cervical medial branch radiofrequency ablation for axial neck pain.

Study Limitations

1
Single case report limits generalizability.
2
Lack of pre-procedure MRI review limits understanding of the exact anatomical factors.
3
Details of previous injections (e.g. injectate volume and concentration) are not available.

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