The Journal of Bone and Joint Surgery (American). 2007;89:2037-2039.
doi:10.2106/JBJS.F.01332
© 2007 The Journal of Bone and Joint Surgery, Inc.
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Epidural Hematoma Causing Paraplegia After a Fluoroscopically Guided Cervical Nerve-Root Injection

A Case Report

Joon Y. Lee, MD1, Ahmad Nassr, MD1 and Ravi K. Ponnappan, MD1

1 Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 5th Avenue, Kaufmann Medical Building, Suite 1010, Pittsburgh, PA 15213

Investigation performed at the Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

The first 150 words of the full text of this article appear below.


   Introduction
 
Extraforaminal cervical nerve-root blocks, administered under image guidance, are extremely useful for both the diagnosis and treatment of cervical radiculopathy. In terms of safety, Ma et al., in their analysis of fluoroscopically guided cervical nerve blocks, found no instances of paralysis in their 1036 patients after injection1. Although devastating neurological complications after cervical transforaminal nerve block are rare, there have been anecdotal case reports of spinal cord infarction2-4, injection into surrounding vascular structures5,6, epidural abscess7, and cerebellar and/or brain-stem herniation and infarction8,9.

An expanding epidural hematoma is a rare complication that can cause major neurological morbidity. Repeated injections, preexisting coagulopathy, and the use of anticoagulation or antiplatelet medications are known risk factors for the development of an epidural hematoma in the lumbar spine after an injection10-13. Injection-related epidural hematomas in the cervical spine have rarely been reported11,14. Consequently, the risk factors for the . . . [Full Text of this Article]


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