While not a cure for the underlying spinal pathology,
cervical epidural steroid injections (CESI)
are an important minimally invasive treatment
for neck pain with radiculopathy. Although CESIs
are considered safe, cervical epidural hematoma
(CEH) is a major complication and has previously
been reported. Patients, who develop CEH, present
with acute neck pain and upper extremity
radiculopathy. A prolonged time to treatment
may lead to worsened neurological outcome.
Diagnostic magnetic resonance imaging and
surgical decompression is the mainstay of treatment.
This report presents a patient with a history
of chronic neck pain and repeat cervical injections,
who presented with increased neck pain
and upper extremity weakness after undergoing
a CESI. Initial radiographic findings were complicated
and inconclusive of a definitive epidural
hematoma. With conservative management, the
patient showed signs of clinical improvement and
ultimately had spontaneous resolution of his CEH.
Though CEH are frequently rapidly progressing
and most often surgically decompressed, some
acutely presenting cases may be approached conservatively.
Though MRI is an important diagnostic
tool for CEH, interpretation of radiographic findings,
following a recent CESI, may be challenging
due to distortion of the epidural space anatomy.
Patients with a history of multiple cervical epidural
injections may have an increased risk for the development
of CEH.
Key words: Cervical epidural steroid injection,
cervical epidural hematoma, spontaneous resolution,
conservative management, magnetic resonance
imaging, complication
Changes in Muscle Morphology in Female Chronic Neck Pain Patients Using Magnetic Resonance Imaging
