Spinal intracord injection damage during interlaminar cervical epidural steroid injection: a case report and review of the literature

Journal of Medical Case Reports, 2024 · DOI: https://doi.org/10.1186/s13256-024-04930-4 · Published: October 29, 2024

Spinal Cord Injury Pain Management Research Methodology & Design

Simple Explanation

This case report describes a rare complication of interlaminar cervical epidural steroid injection (ICESI), where the injection needle damages the spinal cord. The patient, a 47-year-old woman, experienced quadriplegia (paralysis of all four limbs) immediately after the procedure due to the injection damaging the spinal cord. Despite the severity of the initial injury, the patient showed significant neurological improvement over several months with treatment including steroids, hyperbaric oxygen, and acupuncture.

Study Duration

8 months follow-up

Participants

A 47-year-old Chinese woman

Evidence Level

Level 4: Case Report and Literature Review

Key Findings

1
The patient experienced immediate loss of consciousness and quadriplegia following ICESI, indicating spinal intracord injection damage.
2
MRI revealed hyperintensity on T2-weighted images in the spinal cord, extending from C4 to C6 vertebrae, with central cord swelling.
3
The patient demonstrated favorable neurological improvement with normal motor strength in all four extremities and normal spinal cord morphology on MRI at the 8-month follow-up.

Research Summary

This case report describes a rare instance of spinal intracord injection damage during interlaminar cervical epidural steroid injection (ICESI) resulting in quadriplegia. The patient, a 47-year-old woman, underwent ICESI for chronic neck pain and subsequently experienced loss of consciousness and quadriplegia immediately after the procedure. Despite the initial severity, the patient showed remarkable neurological improvement, regaining motor strength and near-normal spinal cord morphology after treatment and rehabilitation.

Practical Implications

Enhanced Fluoroscopic Guidance

The case emphasizes the need for thorough assessment of fluoroscopic guidance during ICESI to minimize the risk of spinal cord injury.

Careful Injection Technique

Clinicians should exercise extreme caution and meticulous technique during ICESI to prevent direct spinal cord trauma or intracord injection.

Informed Consent and Risk Awareness

Patients undergoing ICESI should be fully informed about the potential risks, including rare but severe complications like spinal cord injury.

Study Limitations

1
This is a single case report, limiting generalizability.
2
The exact cause of the intracord injection damage remains unknown.
3
The role of hyperbaric oxygen treatment and acupuncture in the patient's recovery is uncertain.

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