Inadvertent injection of a cervical radicular artery using an atraumatic pencil-point needle.
METHODS
Case report and review of the literature.


OBJECTIVE
To report the first case of inadvertent injection of a cervical radicular artery using an atraumatic pencil-point needle.


BACKGROUND
Rare complications from cervical transforaminal epidural corticosteroid injection have resulted in infarction of the spinal cord and brain. The most often-hypothesized mechanism is inadvertent intra-arterial injection of particulate corticosteroids with a resulting embolus and infarction.


METHODS
Retrospective review of a patient's history and fluoroscopic imaging.


RESULTS
A 30-year-old man with a diagnosed cervical radiculopathy underwent a right C6-C7 transforaminal epidural corticosteroid injection, using a 25-gauge 3.5-inch Whitacre spinal needle. Simultaneous epidural and radicular artery spread were observed under live fluoroscopy. The patient suffered no complications from the procedure.


CONCLUSIONS
This case demonstrates that the use of pencil-point (Whitacre) needles does not eliminate the risk of inadvertent arterial injection during cervical transforaminal epidurals. Further investigation is required to determine whether the incidence of inadvertent vascular injection is reduced with pencil-point needles compared with sharp-beveled needles.
Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA. msmuck@stanord.edu
Matthew
M
Smuck
Daniel
D
Leung
D000328:Adult; D001158:Arteries / Q000187:drug effects; D002574:Cervical Vertebrae / Q000098:blood supply; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D007269:Injections, Intra-Arterial / Q000009:adverse effects; D007278:Injections, Spinal; D008297:Male; D019300:Medical Errors / Q000009:adverse effects; D009339:Needles / Q000009:adverse effects
D003287:Contrast Media