CERVICAL EPIDURAL STEROID INJECTION WITH INTRINSIC SPINAL-CORD DAMAGE- 2 CASE-REPORTS

Study Design. Intrinsic cervical spinal cord damage represents the ser ious and permanent complications that can occur if cervical epidural s teroid injections are administered while the patient is sedated. Two c ase reports are presented. Objectives. To draw attention to the danger ous consequences that can arise from sedating a patient before adminis tering a cervical epidural steroid injection. Summary of Background Da ta. Reported complications of cervical epidural steroid injections hav e been minor and infrequent. No reports of intrinsic cervical cord dam age could be found in a comprehensive English language literature sear ch. Methods. Two case reports of permanent intrinsic cervical cord dam age in patients who had been administered cervical epidural steroid in jections while under intravenous sedation are presented. Magnetic reso nance imaging was performed before and after the administration of cer vical epidural steroid injections. Each patient had herniated nucleus pulposus before they received cervical epidural steroid injections and intrinsic cord damage on postinjection magnetic resonance images. Res ults. Both patients developed increased pain and neurologic symptoms w ithin 24 hours of injection. To date, these symptoms appear to be perm anent. However, Patient 1 had pain relief in her right arm and shoulde r after undergoing a microdiscectomy, but pain was still persistent in her left leg, and she has developed a positive Lhermitte's sign. Conc lusion. These case reports indicate fluoroscopic guidance will not ins ure or prevent intrathecal perforation or spinal cord penetration duri ng the administration of cervical epidural steroid injections. In addi tion, although intravenous sedations during cervical epidural steroid injections have been used numerous times without reported complication s, it appears intravenous sedation in these two cases resulted in the inability of the patient to experience the expected pain and paresthes ias at the time of spinal cord irritation. Therefore, the authors conc lude that the patient should be fully awake during the administration of cervical epidural steroid injections, with only local anesthetic in the skin used for analgesia.