Iatrogenic cervical spinal cord injury after interlaminar cervical epidural injection

Objectives

Describe a catastrophic complication of cervical epidural injection (CEI) in a patient with prior anterior cervical discectomy with fusion (ACDF).

Setting

Interlaminar CEI at C7-T1 was performed under minimal sedation.

Discussion

Right hemiparesis, diffuse dysesthesia, and tactile allodynia were immediately described after the procedure. 24 hours after CEI, an MRI showed an increased T2 signal and decreased T1 signal in the spinal cord extending from C3-T3. Postsurgical ACDF changes, cervicovertebral ligament anomalies, repetitive microtrauma from serial CEI's, and epidural space compromise may have complicated the loss of resistance technique and increased the risk for dural puncture and intrinsic cord injury.

Conclusion

Knowledge of cervical spinal anatomy, biomechanical implications of ACDF, ligamentous inflammation, pre-operative image review, and perioperative patient feedback are valuable insights that may mitigate the risk of severe adverse events.