scholarly journals Spinal Cord Infarction after Cervical Transforaminal Epidural Steroid Injection: Case Report and Literature Review

2017 ◽  
Vol 9 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Jangsup Moon ◽  
Hyung-Min Kwon
Keyword(s):  
Spinal Cord ◽  
Steroid Injection ◽  
Cervical Radiculopathy ◽  
Epidural Steroid Injection ◽  
Spinal Cord Infarction ◽  
Catastrophic Event ◽  
History Of ◽  
Transforaminal Epidural Steroid Injection ◽  
Active Rehabilitation ◽  
Epidural Steroid

Introduction: Transforaminal epidural steroid injection (TFESI) is a widely used nonsurgical procedure in the treatment of patients with radiculopathy. It is efficacious in relieving pain, but a number of complications are being reported. Recently, increasing frequency of major complications, such as spinal cord infarction and cerebral infarction, has been reported with the use of a particulate steroid within fluoroscopic-guided procedures. Methods: We report a 49-year-old man with a history of chronic cervical radiculopathy, who experienced a devastating complication after TFESI. Results: After 2 min of regular TFESI, the patient abruptly experienced muscle weakness in both upper extremities and within 5 min the patient became quadriplegic. Despite active rehabilitation, the patient remained bed-ridden 4 years after the catastrophic event. To our knowledge, this is the first reported case of spinal cord infarction that occurred after TFESI in Korea. Conclusion: Considering the risk of dreadful complications, which appear in an unpredictable manner, TFESI with fluoroscopic guidance should be done only with a nonparticulate steroid.

Spinal Cord Infarction after C7 Transforaminal Epidural Steroid Injection Using Dexamethasone

Clinical Pain ◽  
2020 ◽  
Vol 19 (2) ◽  
pp. 116-119
Author(s):  
Jong Hwa Lee ◽  
Young Sam Kim ◽  
Sang Beom Kim ◽  
Kyeong Woo Lee ◽  
Young Hwan Kim
Keyword(s):  
Spinal Cord ◽  
Steroid Injection ◽  
Epidural Steroid Injection ◽  
Spinal Cord Infarction ◽  
Transforaminal Epidural Steroid Injection ◽  
Epidural Steroid

scholarly journals Spinal cord infarction caused by sacral canal epidural steroid injection

Medicine ◽  
2018 ◽  
Vol 97 (11) ◽  
pp. e0111 ◽  
Author(s):  
Gang Wang ◽  
Jing Liang ◽  
Zishan Jia ◽  
Lei Wan ◽  
Mingxia Yang
Keyword(s):  
Spinal Cord ◽  
Steroid Injection ◽  
Epidural Steroid Injection ◽  
Spinal Cord Infarction ◽  
Sacral Canal ◽  
Epidural Steroid

scholarly journals Right hemidiaphragmatic paralysis after cervical transforaminal epidural steroid injection: illustrative case

2021 ◽  
Vol 1 (19) ◽  
Author(s):  
Molly Farrell ◽  
Ezek Mathew ◽  
Martin Weiss ◽  
Rob Dickerman
Keyword(s):  
Nerve Injury ◽  
Conservative Management ◽  
Phrenic Nerve ◽  
Steroid Injection ◽  
Corticosteroid Injection ◽  
Cervical Radiculopathy ◽  
Epidural Steroid Injection ◽  
Phrenic Nerve Injury ◽  
Transforaminal Epidural Steroid Injection ◽  
Epidural Steroid

BACKGROUND Cervical radiculopathy is a common cause of neck pain, with radiation into the upper extremity in a dermatomal pattern. Corticosteroid injection is a conservative management option with a low risk of major adverse events. No reviewed literature or case reports have implicated phrenic nerve injury secondary to cervical transforaminal epidural steroid injection (CTFESI). OBSERVATIONS A 45-year-old man with severe right C6 radiculopathy secondary to a large right-sided C5–6 herniated intervertebral disc presented to the pain management clinic, where he received a right-sided C6 CTFESI. An hour after injection, the patient experienced shortness of breath, which was found to be caused by right diaphragmatic paralysis. The patient underwent a C5–6 anterior cervical discectomy and fusion, which provided complete relief of his radicular symptoms. However, the right hemidiaphragmatic paralysis remained at the 1-year postoperative visit. LESSONS Thorough literature review showed no established explanations for phrenic nerve injury after CTFESI. In this study, the authors explored the suspected mechanisms of possible injury to the phrenic nerve. Epidural corticosteroid injection is considered to be a safe option for conservative management of cervical radiculopathy. This study unveiled a unique and important adverse event that should be considered before a patient receives CTFESI.

Comparison of Touhy and Quincke needles on intravascular injection rate in lumbar transforaminal epidural block: a randomized prospective trial

2021 ◽  
pp. rapm-2021-102504
Author(s):  
Hyojung Soh ◽  
Yujin Jeong ◽  
Eung Don Kim
Keyword(s):  
Steroid Injection ◽  
Prospective Trial ◽  
Injection Rate ◽  
Epidural Steroid Injection ◽  
Tuohy Needle ◽  
Spinal Cord Infarction ◽  
Procedure Time ◽  
Intravascular Injection ◽  
Transforaminal Epidural Steroid Injection ◽  
Epidural Steroid

BackgroundTransforaminal epidural steroid injection is widely used in clinical practice to effectively deliver injectate into the ventral epidural space. Complications associated with intravascular injection such as spinal cord infarction and paraplegia can occur during transforaminal epidural steroid injection. To improve the safety of the procedure, avoidance of intravascular injection is crucial, for which appropriate needle selection is important. The primary aim of this study was to compare intravascular injection rates during transforaminal epidural steroid injection between commonly used Quincke and Tuohy needles.MethodTwo hundred and four transforaminal epidural steroid injection cases were randomly assigned to one of two needle groups (22-gage Quincke needle or 22-gage Tuohy needle). Intravascular injection was evaluated using digital subtraction angiography. Spread of contrast medium to the ventral and medial epidural spaces was evaluated. Procedure time was compared between the two needle types.ResultsThe overall incidence of intravascular injection was 7.8%. The rate of intravascular injection was significantly lower in the Tuohy needle group than the Quincke needle group (2.9% vs 12.7%, p=0.009). The ventral and medial epidural spread rates of the Tuohy needle group were 92.2% and 95.1%, respectively, significantly higher than those of the Quincke needle group. The procedure time was shorter in the Tuohy needle group than in the Quincke needle group (97.4 (19.3) seconds vs 117.8 (31.9) s; mean difference −20.40 (95% CI −34.35 to −6.45), p=0.005).ConclusionsIn conclusion, Tuohy needles had a lower intravascular injection rate and higher medial and ventral epidural spreading rates than Quincke needles.Trial registration numberKCT0002095.

scholarly journals Conus Medullaris Infarction After a Right L4 Transforaminal Epidural Steroid Injection Using Dexamethasone

2016 ◽  
Vol 8;19 (8;11) ◽  
pp. E1211-E1214 ◽  
Author(s):  
Michael Fakhry
Keyword(s):  
Steroid Injection ◽  
Cauda Equina ◽  
Conus Medullaris ◽  
Epidural Steroid Injection ◽  
Comparable Efficacy ◽  
Spinal Cord Infarction ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Transforaminal Epidural Steroid Injection ◽  
Epidural Steroid

Background: For decades, epidural steroid injections have been an effective tool in the management of many pain related conditions, including lumbar radiculopathy. Transforaminal epidural steroid injections in particular have been reported to potentially result in central nervous system infarctions which have not been reported with interlaminar epidural steroid injections, while providing comparable efficacy. This rare, catastrophic complication has been attributed by some authors to be due to vascular injury secondary to vasospasm, thrombus formation, dissection, as well as concerns with placing the needle at the so-called “safe triangle.” Others, however, have proposed it to be secondary to embolization of the vessel by particulate steroids. This has led to the recommendation of the use of soluble steroids such as dexamethasone when performing TFESI’s, despite concerns over its efficacy and potential for neurotoxicity in the literature. Furthermore, there have also been multiple studies which have revealed that IV dexamethasone is analgesic and that peri-neural dexamethasone is no more effective than IV dexamethasone. Case History: The present case involves a 60-year-old patient with right back and radicular leg pain for 3 years. Two right L4 TFESI’s had been performed with betamethasone several years prior with satisfactory results, until the patient presented to the physician with a pain recurrence of 6 weeks of duration. The patient again underwent a right L4 TFESI with dexamethasone, which provided good relief after 2 weeks. The patient underwent a repeat right L4 TFESI with dexamethasone which was followed by a prompt onset of lower extremity numbness, weakness, and incontinence that was discovered to be related to a conus infarction. While this is the first publicly reported case of a conus medullaris infarction following a lumbar transforaminal injection utilizing dexamethasone, the incidence of these reports may rise as the prevalence of dexamethasone use increases in clinical practice. Conclusion: The spinal cord infarction with TFESI’s may occur related to various mechanisms, regardless of the type of particulate or non-particulate steroid used during these procedures. Key words: Dexamethasone, particulate steroids, non-particulate steroids, conus medullaris infarction, cauda equina syndrome, transforaminal epidural steroid injection, epidural steroid injection, safe triangle, methylprednisolone, paralysis

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