Spinal cord injury produced by direct damage during cervical transforaminal epidural injection

Cervical transforaminal epidural steroid injection (TFESI) has become a common treatment for cervical radiculopathy. We describe a case of spinal cord injury caused by direct injection of iohexol into the cervical spinal cord during cervical TFESI.

A 55-year-old male suffered from intractable pain in the neck, radiating to his left arm. After undergoing C6-7 TFESI under fluoroscopic guidance, the patient reported a shooting pain during needle insertion, and developed quadriparesis shortly after contrast injection. The radiological findings of the contrast medium and air bubble within the cord indicated needle penetration and intracord contrast injection. The paresis of his right arm and both legs recovered within 4 hours after the procedure. At 1-month follow-up, his left arm paresis had continued to improve. One year after the event, the motor paresis improved except for grasping with the left hand, resulting in a claw hand deformity.

This case report draws attention to this very serious complication of cervical TFESI. It is essential to confirm final needle position using both anteroposterior and lateral fluoroscopy before any injection through the needle.