Spinal Cord Injury During Attempted Cervical Interlaminar Epidural Injection of Steroids

Background. Interlaminar cervical epidural injections are commonly performed in the practice of interventional pain medicine. Injury to the spinal cord following injection into the substance of the cord is a known complication of this procedure, but it has rarely been reported and illustrated in the literature. Objective. To describe and analyze a case where an inadvertent injection of contrast medium into the cervical spinal cord occurred. Highlighted is the dissonance between how the procedure was performed and published guidelines for its performance. Presented is the first published oblique fluoroscopic image of an intramedullary injection. Conclusions. By recognizing the potential complications of a procedure, and by describing means of avoiding those complications, practice guidelines serve to reduce the risk, and thereby the incidence of complications. Deviation from established best practice guidelines reinstates risks of complications that can be avoided.