Acute cervical myelopathy with quadriparesis after cervical transforaminal epidural steroid injection

Abstract

Rationale: Cervical transforaminal epidural steroid injection (TFESI), can be an effective tool to improve pain associated with cervical radiculopathy. However, complications related to the procedure have been reported.Patient concerns: A 50-year-old woman who experienced acute cervical myelopathy with quadriparesis after cervical TFESI under fluoroscopic guidance.Diagnoses: The initial post-procedure cervical MRI revealed acute cervical myelopathy Interventions: She received 1000 mg of methylprednisolone was injected intravenously daily for 3 days Outcomes: Improvement in pain, with the only remaining complaints consisting of lingering mild pain in the left hand and occasional hypoesthesia Lessons: Cervical TFESI, despite careful fluoroscopic localization, resulted in spinal cord injury. A spinal cord injury may be treated with conservative treatments, such as medication and rehabilitation.

Does the presence of neuropathic pain affect the outcomes of the interlaminar epidural steroid injection for cervical disc herniation?

“…Therefore, interlaminar approach is often chosen to deliver the drug to cervical epidural space in daily practice. [ 8 ] Although the exact mechanism of action of ESIs has not been fully elucidated yet, they are considered to have some favorable effects on the nociceptive and neuropathic pain generating signal transmission. [ 9 ] Identifying characteristics of patients who are most likely to benefit from ESIs is important to prevent performing this invasive procedure to patients who have low probability of significant pain relief.…”

Spinal intramedullary hematoma presenting years following a cervical epidural injection

“…[ 1 , 4 , 7 , 8 ] CESI may contribute to spinal epidural hematomas and intramedullary cord injections/hematomyelia. [ 2 , 3 , 5 , 6 , 9 ] In this case, the patient’s the MRI-documented intramedullary C3-C6 cystic lesion proved at surgery (i.e. midline myelotomy) to be a chronic intramedullary hematoma.…”

Suspected ischaemic myelopathy following lumbosacral epidural steroid injection in a dog

“…Ischaemic myelopathy is a previously unreported complication following epidural corticosteroid infiltration in veterinary medicine; however, it has been documented in the human medical literature. 6,11,[13][14][15] In humans, the current estimated risk of complications from transforaminal ESI ranges from one in 100,000 to one in a million. 11 The exact mechanism of ischaemic myelopathy following ESI is currently still uncertain; however, the main proposed aetiologies in humans include (a) particulate steroid embolisation secondary to intravascular injection, (b) direct vascular trauma or needle-induced vasospasm, and (c) neurotoxicity from preservative and/or drug vehicle in corticosteroid formulation.…”

“…There have been numerous reports in the human literature of spinal cord infarction following ESI. 11,[13][14][15]20 These cases of spinal cord infarction have been theorised to occur either due to direct vascular injury or embolisation from particulate corticosteroids, with an emphasis on the latter. [6][7][8][9]13,15,16 As such, particulate steroid embolisation was highly suspected in cases where epidural bleeding, epidural abscess or operator error were not identified.…”

“…Ischaemic myelopathy is a previously unreported complication following epidural corticosteroid infiltration in veterinary medicine; however, it has been documented in the human medical literature 6,11,13–15 . In humans, the current estimated risk of complications from transforaminal ESI ranges from one in 100,000 to one in a million 11 .…”