Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Acute Cervical Subdural Hematoma with Quadriparesis after Cervical Transforaminal Epidural Block

  • Lee, Jun Kyu (Department of Neurosurgery, College of Medicine, Chosun University) ;
  • Chae, Ki Whan (Department of Neurosurgery, College of Medicine, Chosun University) ;
  • Ju, Chang Il (Department of Neurosurgery, College of Medicine, Chosun University) ;
  • Kim, Byoung Wook (Department of Neurosurgery, College of Medicine, Chosun University)
  • Received : 2014.09.02
  • Accepted : 2015.01.23
  • Published : 2015.11.28
Download PDF
⟨ Previous Next ⟩

Abstract

Cervical epidural steroid injection is frequently used in the conservative management of neck pain and cervical radiculopathy. Epidural cervical transforaminal injections are usually well-tolerated with mild side effects such as transient decreased sensory and motor function, or headache due to dural puncture. Although there are a few case reports about adverse effects of cervical epidural injection in the literature, it can cause severe complications such as large hematoma, infarction by spinal vascular injury. Subdural hematoma has been occurred much less common rather than epidural hematoma in the spinal cord. We report a rare catastrophic case of cervical spinal subdural hematoma with quadriparesis after cervical transforaminal epidural block.

Keywords

References

  1. Abram SE, O'Connor TC : Complications associated with epidural steroid injections. Reg Anesth 21 : 149-162, 1996
  2. Baker R, Dreyfuss P, Mercer S, Bogduk N : Cervical transforaminal injection of corticosteroids into a radicular artery : a possible mechanism for spinal cord injury. Pain 103 : 211-215, 2003 https://doi.org/10.1016/S0304-3959(02)00343-3
  3. Bose B : Quadriparesis following cervical epidural steroid injections : case report and review of the literature. Spine J 5 : 558-563, 2005 https://doi.org/10.1016/j.spinee.2005.03.015
  4. Brouwers PJ, Kottink EJ, Simon MA, Prevo RL : A cervical anterior spinal artery syndrome after diagnostic blockade of the right C6-nerve root. Pain 91 : 397-399, 2001 https://doi.org/10.1016/S0304-3959(00)00437-1
  5. Cicala RS, Thoni K, Angel JJ : Long-term results of cervical epidural steroid injections. Clin J Pain 5 : 143-145, 1989 https://doi.org/10.1097/00002508-198906000-00003
  6. Cicala RS, Westbrook L, Angel JJ : Side effects and complications of cervical epidural steroid injections. J Pain Symptom Manage 4 : 64-66, 1989 https://doi.org/10.1016/0885-3924(89)90024-9
  7. Derby R, Lee SH, Date ES, Lee JH, Lee CH : Size and aggregation of corticosteroids used for epidural injections. Pain Med 9 : 227-234, 2008 https://doi.org/10.1111/j.1526-4637.2007.00341.x
  8. Derby R, Lee SH, Kim BJ, Chen Y, Seo KS : Complications following cervical epidural steroid injections by expert interventionalists in 2003. Pain Physician 7 : 445-449, 2004
  9. DeSio JM, Kahn CH, Warfield CA : Facial flushing and/or generalized erythema after epidural steroid injection. Anesth Analg 80 : 617-619, 1995
  10. Ferrante FM, Wilson SP, Iacobo C, Orav EJ, Rocco AG, Lipson S : Clinical classification as a predictor of therapeutic outcome after cervical epidural steroid injection. Spine (Phila Pa 1976) 18 : 730-736, 1993 https://doi.org/10.1097/00007632-199305000-00010
  11. Furman MB, Giovanniello MT, O'Brien EM : Incidence of intravascular penetration in transforaminal cervical epidural steroid injections. Spine (Phila Pa 1976) 28 : 21-25, 2003 https://doi.org/10.1097/00007632-200301010-00007
  12. Heath ML : Deaths after intravenous regional anaesthesia. Br Med J (Clin Res Ed) 285 : 913-914, 1982 https://doi.org/10.1136/bmj.285.6346.913
  13. Hodges SD, Castleberg RL, Miller T, Ward R, Thornburg C : Cervical epidural steroid injection with intrinsic spinal cord damage. Two case reports. Spine (Phila Pa 1976) 23 : 2137-2142; discussion 2141-2142, 1998 https://doi.org/10.1097/00007632-199810010-00020
  14. Hoeft MA, Rathmell JP, Monsey RD, Fonda BJ : Cervical transforaminal injection and the radicular artery : variation in anatomical location within the cervical intervertebral foramina. Reg Anesth Pain Med 31 : 270-274, 2006
  15. Huntoon MA : Anatomy of the cervical intervertebral foramina : vulnerable arteries and ischemic neurologic injuries after transforaminal epidural injections. Pain 117 : 104-111, 2005 https://doi.org/10.1016/j.pain.2005.05.030
  16. Huntoon MA : Anterior spinal artery syndrome as a complication of transforaminal epidural steroid injections. Semin Pain Med 2 : 204-207, 2004 https://doi.org/10.1016/j.spmd.2004.09.010
  17. Karasek M, Bogduk N : Temporary neurologic deficit after cervical transforaminal injection of local anesthetic. Pain Med 5 : 202-205, 2004 https://doi.org/10.1111/j.1526-4637.2004.04028.x
  18. Kim SB, Kim MK, Kim KD, Lim YJ : Unintended complication of intracranial subdural hematoma after percutaneous epidural neuroplasty. J Korean Neurosurg Soc 55 : 170-172, 2014 https://doi.org/10.3340/jkns.2014.55.3.170
  19. Muro K, O'Shaughnessy B, Ganju A : Infarction of the cervical spinal cord following multilevel transforaminal epidural steroid injection : case report and review of the literature. J Spinal Cord Med 30 : 385-388, 2007 https://doi.org/10.1080/10790268.2007.11753957
  20. Nelson DA : Dangers from methylprednisolone acetate therapy by intraspinal injection. Arch Neuro 45 : 804-806, 1988 https://doi.org/10.1001/archneur.1988.00520310122029
  21. Petitjeans F, Mion G, Puidupin M, Tourtier JP, Hutson C, Saissy JM : Tachycardia and convulsions induced by accidental intravascular ropivacaine injection during sciatic block. Acta Anaesthesiol Scand 46 : 616-617, 2002 https://doi.org/10.1034/j.1399-6576.2002.460524.x
  22. Reitman CA, Watters W 3rd : Subdural hematoma after cervical epidural steroid injection. Spine (Phila Pa 1976) 27 : E174-E176, 2002 https://doi.org/10.1097/00007632-200203150-00022
  23. Rowlingson JC, Kirschenbaum LP : Epidural analgesic techniques in the management of cervical pain. Anesth Analg 65 : 938-942, 1986
  24. Rozin L, Rozin R, Koehler SA, Shakir A, Ladham S, Barmada M, et al. : Death during transforaminal epidural steroid nerve root block (C7) due to perforation of the left vertebral artery. Am J Forensic Med Pathol 24 : 351-355, 2003 https://doi.org/10.1097/01.paf.0000097790.45455.45
  25. Scanlon GC, Moeller-Bertram T, Romanowsky SM, Wallace MS : Cervical transforaminal epidural steroid injections : more dangerous than we think? Spine (Phila Pa 1976) 32 : 1249-1256, 2007 https://doi.org/10.1097/BRS.0b013e318053ec50
  26. Shulman M : Treatment of neck pain with cervical epidural steroid injection. Reg Anesth Pain Med 11 : 92-94, 1986
  27. Smuck M, Fuller BJ, Chiodo A, Benny B, Singaracharlu B, Tong H, et al. : Accuracy of intermittent fluoroscopy to detect intravascular injection during transforaminal epidural injections. Spine (Phila Pa 1976) 33 : E205-E210, 2008 https://doi.org/10.1097/BRS.0b013e31816960fe
  28. Smuck M, Maxwell MD, Kennedy D, Rittenberg JD, Lansberg MG, Plastaras CT : Utility of the anesthetic test dose to avoid catastrophic injury during cervical transforaminal epidural injections. Spine J 10 : 857-864, 2010 https://doi.org/10.1016/j.spinee.2010.07.003
  29. Wells-Roth D, Zonenshayn M : Vascular anatomy of the spine. Oper Tech Neurosurg 6 : 116-121, 2003 https://doi.org/10.1053/S1092-440X(03)00037-9

Cited by

  1. New Optimal Needle Entry Angle for Cervical Transforaminal Epidural Steroid Injections: A Retrospective Study vol.14, pp.4, 2015, https://doi.org/10.7150/ijms.17112
  2. Spinal Cord Infarction after Cervical Transforaminal Epidural Steroid Injection: Case Report and Literature Review vol.9, pp.1, 2015, https://doi.org/10.1159/000455069
  3. Neuraxial blocks and spinal haematoma: Review of 166 case reports published 1994-2015. Part 1: Demographics and risk-factors vol.15, pp.1, 2015, https://doi.org/10.1016/j.sjpain.2016.11.008
  4. Spontaneous lumbar spinal subdural hematoma: a case report vol.33, pp.3, 2015, https://doi.org/10.1080/02688697.2017.1327021
  5. Risk Factor Analysis and Surgical Outcomes of Acute Spontaneous Spinal Subdural Hematoma. An Institutional Experience of Four Cases and Literature Review vol.146, pp.None, 2015, https://doi.org/10.1016/j.wneu.2020.10.096