Inadvertent Subdural Injection during Cervical Transforaminal Epidural Steroid Injection
Serious complications following cervical epidural steroid injection are rare. Subdural injection of local anesthetic and steroid represents a rare but potentially life threatening complication. A patient presented with left sided cervical pain radiating into the left upper extremity with motor defic...
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2013-01-01
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Series: | Case Reports in Anesthesiology |
Online Access: | http://dx.doi.org/10.1155/2013/847085 |
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doaj-d74bb1ad6da14f8eb3635c876b98714e2020-11-24T23:57:04ZengHindawi LimitedCase Reports in Anesthesiology2090-63822090-63902013-01-01201310.1155/2013/847085847085Inadvertent Subdural Injection during Cervical Transforaminal Epidural Steroid InjectionKesavan Sadacharam0Jeffrey D. Petersohn1Michael S. Green2Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, PA 19102, USADrexel University College of Medicine, Pain Care PC, Linwood, NJ 08221, USADrexel University College of Medicine, Hahnemann University Hospital, Philadelphia, PA 19102, USASerious complications following cervical epidural steroid injection are rare. Subdural injection of local anesthetic and steroid represents a rare but potentially life threatening complication. A patient presented with left sided cervical pain radiating into the left upper extremity with motor deficit. MRI showed absent lordosis with a broad left paramedian disc-osteophyte complex impinging the spinal cord at C5-6. During C5-6 transforaminal epidural steroid injection contrast in AP fluoroscopic view demonstrated a subdural contrast pattern. The needle was withdrawn slightly and repositioned. Normal lateral epidural and nerve root contrast pattern was subsequently obtained and injection followed with immediate improvement in radicular symptoms. There were no postoperative complications on subsequent clinic follow-up. The subdural space is a potential space between the arachnoid and dura mater. As the subdural space is larger in the cervical region, there may be an elevated potential for inadvertent subdural injection. Needle placement in the cervical subdural space during transforaminal injection is uncommon. Failure to identify aberrant needle entry within the cervical subdural space may result in life threatening complications. We recommend initial injection of a limited volume of contrast agent to detect inadvertent subdural space placement.http://dx.doi.org/10.1155/2013/847085 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Kesavan Sadacharam Jeffrey D. Petersohn Michael S. Green |
spellingShingle |
Kesavan Sadacharam Jeffrey D. Petersohn Michael S. Green Inadvertent Subdural Injection during Cervical Transforaminal Epidural Steroid Injection Case Reports in Anesthesiology |
author_facet |
Kesavan Sadacharam Jeffrey D. Petersohn Michael S. Green |
author_sort |
Kesavan Sadacharam |
title |
Inadvertent Subdural Injection during Cervical Transforaminal Epidural Steroid Injection |
title_short |
Inadvertent Subdural Injection during Cervical Transforaminal Epidural Steroid Injection |
title_full |
Inadvertent Subdural Injection during Cervical Transforaminal Epidural Steroid Injection |
title_fullStr |
Inadvertent Subdural Injection during Cervical Transforaminal Epidural Steroid Injection |
title_full_unstemmed |
Inadvertent Subdural Injection during Cervical Transforaminal Epidural Steroid Injection |
title_sort |
inadvertent subdural injection during cervical transforaminal epidural steroid injection |
publisher |
Hindawi Limited |
series |
Case Reports in Anesthesiology |
issn |
2090-6382 2090-6390 |
publishDate |
2013-01-01 |
description |
Serious complications following cervical epidural steroid injection are rare. Subdural injection of local anesthetic and steroid represents a rare but potentially life threatening complication. A patient presented with left sided cervical pain radiating into the left upper extremity with motor deficit. MRI showed absent lordosis with a broad left paramedian disc-osteophyte complex impinging the spinal cord at C5-6. During C5-6 transforaminal epidural steroid injection contrast in AP fluoroscopic view demonstrated a subdural contrast pattern. The needle was withdrawn slightly and repositioned. Normal lateral epidural and nerve root contrast pattern was subsequently obtained and injection followed with immediate improvement in radicular symptoms. There were no postoperative complications on subsequent clinic follow-up. The subdural space is a potential space between the arachnoid and dura mater. As the subdural space is larger in the cervical region, there may be an elevated potential for inadvertent subdural injection. Needle placement in the cervical subdural space during transforaminal injection is uncommon. Failure to identify aberrant needle entry within the cervical subdural space may result in life threatening complications. We recommend initial injection of a limited volume of contrast agent to detect inadvertent subdural space placement. |
url |
http://dx.doi.org/10.1155/2013/847085 |
work_keys_str_mv |
AT kesavansadacharam inadvertentsubduralinjectionduringcervicaltransforaminalepiduralsteroidinjection AT jeffreydpetersohn inadvertentsubduralinjectionduringcervicaltransforaminalepiduralsteroidinjection AT michaelsgreen inadvertentsubduralinjectionduringcervicaltransforaminalepiduralsteroidinjection |
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