Quadriparesis following cervical epidural steroid injections: case report and review of the literature.
BACKGROUND
Cervical epidural steroid injections are frequently used in the conservative management of neck pain, cervical radiculitis, and cervical radiculopathy. Between 64-76% of patients who receive injections report subjective pain improvement. Injections are usually well-tolerated with only mild, transient side effects, although a few case reports of patients with adverse effects do appear in the literature. Some clinicians have expressed concerns about epidural injections above the C7-T1 level, and in the use of methylprednisolone epidurally; as yet, neither is a consensus viewpoint.


OBJECTIVE
This case report describes severe adverse effects (quadriplegia and respiratory arrest) associated with an epidural injection into the C6-C7 space. Although the patient's symptoms improved somewhat with supportive care, quadriparesis appears irreversible. No reports of quadriparesis after cervical epidural injection were found in the literature, although other adverse effects have been reported.


METHODS
The patient was injected by a fellowship-trained pain management specialist in an outpatient surgicenter using C-arm fluoroscopic guidance. Immediately he experienced respiratory arrest with quadriplegia. He was intubated and transferred to the hospital, then transferred again to Christiana Health Care Services.


METHODS
The patient was hospitalized, treated with steroid protocol within 8 hours, and followed clinically for 6 months.


RESULTS
Magnetic resonance imaging within 6 hours of the injury and 6 months later showed no significant findings aside from lordosis (40 degrees angle) of the cervical spine at the C6-C7 level.


CONCLUSIONS
Although evidence is not conclusive, this patient may have suffered a vascular event from a cervical epidural injection.
Bose
Bikash
B
Department of Neurosurgery, Christiana Care Health System, C79 Omega Drive, Newark, DE 19713, USA. ranal@msn.com
D002574:Cervical Vertebrae; D006801:Humans; D007268:Injections, Epidural / Q000009:adverse effects*; D008297:Male; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage*; D008875:Middle Aged; D019547:Neck Pain / Q000188:drug therapy*; D011782:Quadriplegia / Q000209:etiology*; D012131:Respiratory Insufficiency / Q000209:etiology
D017258:Medroxyprogesterone Acetate