Abstract
BACKGROUNDNeck pain is often chronic and disabling. Cervical facet joint injections and epidural steroid injections are frequently used to manage chronic neck pain and cervicogenic headaches. While minimal side effects are commonly associated with these treatments, severe complications are exceedingly rare.OBSERVATIONSThe authors report 4 cases of iatrogenic neurological injury after radiofrequency ablation (RFA) and epidural steroid injections. One patient experienced left shoulder, scapular, and arm pain with left arm and hand weakness that developed immediately after RFA for chronic neck pain. Electromyography/nerve conduction velocity (EMG/NCV) studies confirmed denervation changes in the left C8–T1 distribution. Three patients complained of numbness and weakness of the hands immediately after an interlaminar cervical epidural block. One of these patients underwent EMG/NCV that confirmed denervation changes occurring in the left C8–T1 distribution.LESSONSSpine surgeons and pain management specialists should be aware of neurological injuries that may occur after cervical RFA and epidural steroid injections, especially after a multilevel cervical procedure and with severe cervical spinal stenosis. EMG/NCV studies plays an important role in detecting and localizing neurological injury and in differentiating from conditions that mimic cervical root injuries, including brachial plexus trauma due to positioning and Parsonage-Turner syndrome.
Highlights
Neck pain is often chronic and disabling
We present 4 exceedingly rare cases of patients who experienced a neurological injury after radiofrequency ablation (RFA) and epidural steroid injections
Gabapentin, and intrathecal baclofen, the patient continued to experience severe neck pain. He underwent a three-level anterior cervical discectomy with placement of intervertebral allograft followed by a C4 laminectomy and C3–4 and C4–5 bilateral foraminotomies with a posterior cervical fusion from C3 to C6
Summary
Neck pain is often chronic and disabling. Cervical facet joint injections and epidural steroid injections are frequently used to manage chronic neck pain and cervicogenic headaches. Three patients complained of numbness and weakness of the hands immediately after an interlaminar cervical epidural block One of these patients underwent EMG/ NCV that confirmed denervation changes occurring in the left C8–T1 distribution. LESSONS Spine surgeons and pain management specialists should be aware of neurological injuries that may occur after cervical RFA and epidural steroid injections, especially after a multilevel cervical procedure and with severe cervical spinal stenosis. The narrowest anteroposterior (AP) diameter of cervical spinal stenosis was determined for cases 2–4
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