Cervical epidural injection complicated by syrinx formation: a case report

Abstract

Study design: Case report and review of literature.

Objective: Review the common side-effects of interlaminar cervical epidural injection (CEI) and to report a novel complication of this procedure. SUMMARY OF BACKGROUND AND DATA: CEIs are commonly used to treat chronic radicular neck pain. Several minor and major complications have been reported in literature. We report a rare complication of syrinx formation resulting from a CEI.

Methods: A 52-year-old woman presented from an outside hospital after undergoing a CEI. Under fluoroscopic guidance, an epidural needle was inserted at C7-T1 level. Radiologic contrast showed appropriate epidural spread. Shortly after waking up from the procedure, the patient complained of inability to move her right arm and leg, numbness of her right hemibody below the neck, and urinary retention.

Results: Magnetic resonance imaging of the spine revealed a syrinx extending from the C1 to T4 levels. There was no evidence of epidural collection or blood.

Conclusion: Interlaminar CEI is thought to be a relatively safe procedure. Spinal cord injury is a documented complication of spinal anesthesia at any level of the spinal cord, even with fluoroscopic guidance, but most complications are thought to be minor and transient in nature. Syrinx formation with focal myelomalacia following spinal anesthesia has been reported in the lumbar area Pradhan et al, J Neurol Sci 2006;251:70-2, but we know of no existing reports involving the cervical region. We report this rare complication in this case report.