Spinal intracord injection damage during interlaminar cervical epidural steroid injection: a case report and review of the literature

Interlaminar cervical epidural steroid injection are commonly performed in the practice of interventional pain medicine. Spinal cord damage following injection into the substance of the cord is a known complication of this procedure. Only four cases have been reported in the literature, all of which have been associated with poor prognosis.

A 47-year-old Chinese woman with chronic neck pain underwent interlaminar cervical epidural steroid injection in C5–C6 space under local anesthesia using C-arm fluoroscopic guidance. Immediately after the procedure, she experienced loss of consciousness and quadriplegia. She was subsequently transferred to the orthopedic department and treated for 2 weeks before being transferred to the rehabilitation department for additional 2 weeks. The magnetic resonance imaging performed 8 hours after the injection revealed hyperintensity on T2-weighted images in the spinal cord extending from C4 to C6 vertebrae, with central cord swelling toward the right. She received standard methylprednisolone therapy within 8 hours of the injury, as well as hyperbaric oxygen treatment and acupuncture during her hospitalization. Her neurological symptoms gradually improved, ultimately demonstrating normal motor strength in all four extremities, with slight numbness in the right arm and normal spinal cord morphology on magnetic resonance imaging at the 8-month follow-up.

This case represents a rare instance of spinal intracord injection damage during ICESI resulting in quadriplegia, with subsequent favorable neurological improvement.