Convulsion Caused by a Lidocaine Test in Cervical Transforaminal Epidural Steroid Injection

Abstract

Cervical transforaminal epidural steroid injections (CTFESI) have been used to treat cervical radicular pain with the rationale of suppressing spinal nerve root inflammation. However, potential serious procedure-related complications demand several protective measures, such as careful placement of a needle tip at the posterior wall of the neural foramen; real-time fluoroscopic surveillance of contrast flow, preferably with digital subtraction; and a local anesthetic test just before injection of the steroid [1,2]. The purpose of a local nesthetic test is to detect any temporary and reversible neurologic signs of intravascular nstillation of a short-duration local anesthetic agent so that subsequent steroid injection hat may potentially result in permanent neurologic complications can be withheld [1,3]. ince the test dose was advocated, only 2 reports [1,2] have described the value of the test y presenting cases of temporary neurologic deficits. More cases or research is needed to etermine whether and how the test should be done [1]. The present case report discusses onvulsion caused by a local anesthetic test because of inadvertent vertebral artery injection.