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. 2023 Nov 2;2(4):100288.
doi: 10.1016/j.inpm.2023.100288. eCollection 2023 Dec.

Iatrogenic cervical spinal cord injury after interlaminar cervical epidural injection

Ranjeev Chabra  1 , Chun Maung  2 , Theresa Pazionis  3 , Behnum Habibi  1
Affiliations

Iatrogenic cervical spinal cord injury after interlaminar cervical epidural injection

Ranjeev Chabra et al. Interv Pain Med. .

Abstract

Objectives: Describe a catastrophic complication of cervical epidural injection (CEI) in a patient with prior anterior cervical discectomy with fusion (ACDF).

Setting: Interlaminar CEI at C7-T1 was performed under minimal sedation.

Discussion: Right hemiparesis, diffuse dysesthesia, and tactile allodynia were immediately described after the procedure. 24 hours after CEI, an MRI showed an increased T2 signal and decreased T1 signal in the spinal cord extending from C3-T3. Postsurgical ACDF changes, cervicovertebral ligament anomalies, repetitive microtrauma from serial CEI's, and epidural space compromise may have complicated the loss of resistance technique and increased the risk for dural puncture and intrinsic cord injury.

Conclusion: Knowledge of cervical spinal anatomy, biomechanical implications of ACDF, ligamentous inflammation, pre-operative image review, and perioperative patient feedback are valuable insights that may mitigate the risk of severe adverse events.

Keywords: Cervical; Cord; Epidural; Injection; Injury; Spinal.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
T2-weighted MRI axial and sagittal images of the cervical spine 24 hours after SCI presentation. Images (1–6.) R: Right; P: Posterior; A: Anterior; I: Inferior; mm: millimeters (1): T2 Sagittal view just right of midline highlighting extent of fluid signal and cord injury. (2): T2 axial view at C3–C4 level demonstrating fluid signal within the cord. (3): T2 axial view at C4–C5 level demonstrating fluid signal within the cord. (4): T2 axial view at T2 level demonstrating fluid signal within the cord. (5): T2 axial view at C7-T1 injection level demonstrating fluid signal within the cord and 12.49mm anteroposterior diameter (seen in green). (6): T2 axial view at C7-T1 injection level demonstrating fluid signal within the cord and 1.59mm epidural space (seen in green). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
See this image and copyright information in PMC

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