title: Transient tetraplegia after cervical facet joint injection for chronic neck pain administered without imaging guidance.
abstract: We report about a patient in whom transient tetraplegia with intact proprioception occurred immediately after infiltration of a facet joint at the C6 level guided by anatomical landmarks. After positioning the patient supine and applying atropine and oxygen, respiration and circulation were stable and all symptoms resolved within the next 30 min. The type of neurological pattern and the course of disease suggest an inadvertent injection into a cervical radicular artery that reinforces the anterior spinal artery. This complication is potentially serious and may be permanently disabling or life threatening. It should be considered by any clinician performing "blind" zygapophysial joint injections in the cervical spine. Using imaging guidance should help prevent this type of complication.
authors.affiliation: Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany. josef.heckmann@neuro.imed.uni-erlangen.de
authors.forename: Josef G
authors.initials: JG
authors.lastname: Heckmann
authors.forename: Christian
authors.initials: C
authors.lastname: Maihöfner
authors.forename: Stefan
authors.initials: S
authors.lastname: Lanz
authors.forename: Christophe
authors.initials: C
authors.lastname: Rauch
authors.forename: Bernhard
authors.initials: B
authors.lastname: Neundörfer
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000009:adverse effects*; D001158:Arteries / Q000293:injuries; D001285:Atropine / Q000627:therapeutic use; D001919:Bradycardia / Q000139:chemically induced / Q000503:physiopathology; D002574:Cervical Vertebrae / Q000503:physiopathology / Q000601:surgery*; D002908:Chronic Disease / Q000628:therapy; D003952:Diagnostic Imaging / Q000592:standards; D005260:Female; D006801:Humans; D007022:Hypotension / Q000139:chemically induced / Q000503:physiopathology; D007049:Iatrogenic Disease / Q000517:prevention & control; D007267:Injections / Q000009:adverse effects; D008012:Lidocaine / Q000009:adverse effects; D008991:Monitoring, Physiologic / Q000592:standards; D018727:Muscarinic Antagonists / Q000627:therapeutic use; D019547:Neck Pain / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D010100:Oxygen / Q000627:therapeutic use; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D011782:Quadriplegia / Q000139:chemically induced* / Q000503:physiopathology; D013116:Spinal Cord / Q000098:blood supply / Q000187:drug effects* / Q000503:physiopathology; D021801:Zygapophyseal Joint / Q000294:innervation / Q000503:physiopathology / Q000601:surgery*
chemical_list: D000779:Anesthetics, Local; D018727:Muscarinic Antagonists; D001285:Atropine; D008012:Lidocaine; D010100:Oxygen