Clinical Pain

Korean Association of Pain Medicine (대한임상통증학회)
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Spinal Cord Infarction after C7 Transforaminal Epidural Steroid Injection Using Dexamethasone

덱사메타손을 이용한 경추 7번 경막 외 스테로이드 주사 후 척수 경색

  • Lee, Jong Hwa (Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine) ;
  • Kim, Young Sam (Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine) ;
  • Kim, Sang Beom (Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine) ;
  • Lee, Kyeong Woo (Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine) ;
  • Kim, Young Hwan (Department of Physical Medicine and Rehabilitation, Medwill Hospital)
  • 이종화 (동아대학교 의과대학 동아대학교병원 재활의학과) ;
  • 김영삼 (동아대학교 의과대학 동아대학교병원 재활의학과) ;
  • 김상범 (동아대학교 의과대학 동아대학교병원 재활의학과) ;
  • 이경우 (동아대학교 의과대학 동아대학교병원 재활의학과) ;
  • 김영환 (메드윌 병원 재활의학과)
  • Received : 2020.03.27
  • Accepted : 2020.07.10
  • Published : 2020.12.31
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Abstract

Cervical transforaminal epidural steroid injection (TFESI) is commonly performed to provide relief of pain caused by radiculopathy. Intra-arterial injection of particulate steroid or direct needle injury can lead to spinal artery embolism or thrombosis. Also there is a possibility of vascular spasm. To our knowledge, this is the first reported case of spinal cord infarction that occurred after TFESI with non-particulate steroid in Korea. A 47-year-old female patient underwent C7 TFESI at local pain clinic. Injected materials were dexamethasone and mepivacaine. Right after the intervention, she felt muscle weakness and decreased sensation. On physical examination, she had decreased sensation from C4 to T2 dermatome in light touch and pin-prick test. Proprioception and vibration were intact. The motor grades of upper extremities were grade 1. Cervical and thoracic spine MRI was checked. Diffusion-weighted image and apparent diffusion coefficient image showed long extension of spinal cord infarction from C2 to T1 level.

Keywords

References

  1. Bush K, Hillier S. Outcome of cervical radiculopathy treated with periradicular/epidural corticosteroid injections: a prospective study with independent clinical review. Eur Spine J 1996; 5: 319-325 https://doi.org/10.1007/BF00304347
  2. Molloy RE, Benzon HT. Interlaminar epidural steroid injections for lumbosacral radiculopathy. In: Benzon HT, Raja SN, Molloy RE, Liu SS, Fishman SM, editors: Essentials of Pain Medicine and Regional Anesthesia, 2nd ed, Philadelphia: Churchill Livingstone, 2005, 331-340
  3. Scanlon GC, Moeller-Bertram T, Romanowsky SM, Wallace MS. Cervical transforaminal epidural steroid injections: more dangerous than we think? Spine 2007; 32: 1249-1256 https://doi.org/10.1097/BRS.0b013e318053ec50
  4. Tiso RL, Cutler T, Catania JA, Whalen K. Adverse central nervous system sequelae after selective transforaminal block: the role of corticosteroids. Spine J 2004; 4: 468-474 https://doi.org/10.1016/j.spinee.2003.10.007
  5. Dietrich TJ, Sutter R, Froehlich JM, Pfirrmann CWA. Particulate versus non-particulate steroids for lumbar transforaminal or interlaminar epidural steroid injections: an update. Skeletal Radiol 2015; 44: 149-155 https://doi.org/10.1007/s00256-014-2048-6
  6. Derby R, Lee SH, Date ES, Lee JH, Lee CH. Size and aggregation of corticosteroids used for epidural injections. Pain Med 2008; 9: 227-234 https://doi.org/10.1111/j.1526-4637.2007.00341.x
  7. Brouwers PJAM, Kottink EJBL, Simon MAM, Prevo RL. A cervical anterior spinal artery syndrome after diagnostic blockade of the right C6-nerve root. Pain 2001; 91: 397-399 https://doi.org/10.1016/s0304-3959(00)00437-1
  8. Simeone FA, Ryan KG, Cotter JR. Prolonged experimental cerebral vasospasm. J Neurosurg 1968; 29: 357-366 https://doi.org/10.3171/jns.1968.29.4.0357
  9. Furman MB, Giovanniello MT, O'Brien EM. Incidence of intravascular penetration in transforaminal cervical epidural steroid injections. Spine 2003; 28: 21-25 https://doi.org/10.1097/00007632-200301010-00007
  10. Florey H. Microscopical observations on the circulation of the blood in the cerebral cortex. Brain 1925; 48: 43-64 https://doi.org/10.1093/brain/48.1.43