Unnecessary Cervical Epidural Injection in An Octogenarian

Area of Science:

• Neurology
• Pain Management
• Interventional Procedures

Background:

• Cervical epidural injections (ESI) lack documented long-term efficacy.
• Cervical ESI carry risks of intramedullary injection, leading to neurological deficits, and intravascular injection, potentially causing stroke.

Observation:

• An elderly male patient with chronic neck pain but no neurological deficit underwent two cervical ESI.
• The patient had a history of myocardial infarction and was on aspirin (ASA), which was discontinued for 5 days prior to each injection, increasing his risk of thrombotic events.

Findings:

• The patient had no neurological deficit or significant cervical CT findings, making the ESI medically questionable.
• Stopping aspirin (ASA) for the procedure increased the patient's risk of cardiac-stent related thrombosis and stroke.

Implications:

• Cervical ESI should be carefully considered due to lack of efficacy and significant potential complications.
• Patient selection for cervical ESI must rigorously exclude individuals without clear indications and with contraindicating medical conditions or medications.