Medullary Cord Injury After Interlaminar Cervical Epidural Steroid Injections: Two Case Reports

While the complications of cervical epidural steroid injections have been closely studied, there have been no reports of medullary cord injury, including myelopathy, myelomalacia, or syringomyelia, after these injections. We report here a case of myelopathy progressing to myelomalacia and a case of syringomyelia after properly performed cervical intralaminar epidural steroid injections.

One case was characterized by a long history of advanced cervical spondylosis, the other by a distant history of cervical trauma. In neither case was there any evidence to suggest that the patients were at risk for medullary cord injury.

Epidural injections can generate clinically significant pressure changes in susceptible patients. Flexion and rotation of the neck should be done if unexpected pain occurs after an injection. These adverse outcomes, while rare, can occur in the absence of any departure from the standard of care on the part of the performing physician.