%0 Journal Article
%T Inadvertent Subdural Injection during Cervical Transforaminal Epidural Steroid Injection
%A Kesavan Sadacharam
%A Jeffrey D. Petersohn
%A Michael S. Green
%J Case Reports in Anesthesiology
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/847085
%X 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 The needle was withdrawn slightly and repositioned.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. 1. Introduction Cervical radiculopathy is a common condition affecting 83 per 100,000 persons each year [1]. The cause varies by patient age with intervertebral disc herniation common in younger persons and spondylosis predominating in the older age group. Cervical spondylosis is present in 75% of patients older than 65 years of age. Both pathologies can produce anatomic stenosis resulting in impingement or compression of nerve roots or spinal cord. Presenting symptoms include cervical pain with or without radiculopathic upper extremity pain, weakness, deep tendon reflex depression, headache, or vertigo. Duration and severity of symptoms directs selection of treatment modality. Common conservative treatment consists of nonsteroidal anti-inflammatory drugs, anticonvulsants, muscle relaxants, and physical therapy. Efficacy of cervical epidural steroid injection for patients unresponsive to conservative treatment has been demonstrated [2¨C4]. Symptoms refractory to interventional care or demonstrating myelopathic symptoms of spinal cord compression necessitate consideration for surgical intervention. Epidural injection in the cervical spine can be performed by interlaminar or transforaminal approaches. Transforaminal
%U http://www.hindawi.com/journals/cria/2013/847085/