Cervical epidural steroid injection with intrinsic XXXX . Two case reports.

@entity1 @entity602 @entity158
STUDY DESIGN: Intrinsic cervical @entity602 represents the serious and permanent complications that can occur if cervical epidural steroid injections are administered while the @entity1 is sedated. Two case reports are presented. OBJECTIVES: To draw attention to the dangerous consequences that can arise from sedating a @entity1 before administering a cervical epidural steroid injection. SUMMARY OF BACKGROUND DATA: Reported complications of cervical epidural steroid injections have been minor and infrequent. No reports of intrinsic cervical @entity602 could be found in a comprehensive English language literature search. METHODS: Two case reports of permanent intrinsic cervical @entity602 in @entity1 who had been administered cervical epidural steroid injections while under intravenous sedation are presented. Magnetic resonance imaging was performed before and after the administration of cervical epidural steroid injections. Each @entity1 had herniated nucleus pulposus before they received cervical epidural steroid injections and intrinsic @entity602 on postinjection magnetic resonance images. RESULTS: Both @entity1 developed @entity158 and neurologic symptoms within 24 hours of injection. To date, these symptoms appear to be permanent. However, @entity1 1 had @entity158 relief in her right arm and shoulder after undergoing a microdiscectomy, but @entity158 was still persistent in her left leg, and she has developed a positive Lhermitte's sign. CONCLUSION: These case reports indicate fluoroscopic guidance will not insure or prevent intrathecal perforation or spinal cord penetration during the administration of cervical epidural steroid injections. In addition, although intravenous sedations during cervical epidural steroid injections have been used numerous times without reported complications, it appears intravenous sedation in these two cases resulted in the inability of the @entity1 to experience the expected @entity158 and paresthesias at the time of spinal cord irritation. Therefore, the authors conclude that the @entity1 should be fully awake during the administration of cervical epidural steroid injections, with only local anesthetic in the skin used for analgesia.
