Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA.
Spine (Phila Pa 1976). 2011 Feb 1;36(3):E220-3. doi: 10.1097/BRS.0b013e3181f13417.
Case report and review of the literature.
To report the first case of inadvertent injection of a cervical radicular artery using an atraumatic pencil-point needle.
Rare complications from cervical transforaminal epidural corticosteroid injection have resulted in infarction of the spinal cord and brain. The most often-hypothesized mechanism is inadvertent intra-arterial injection of particulate corticosteroids with a resulting embolus and infarction.
Retrospective review of a patient's history and fluoroscopic imaging.
A 30-year-old man with a diagnosed cervical radiculopathy underwent a right C6-C7 transforaminal epidural corticosteroid injection, using a 25-gauge 3.5-inch Whitacre spinal needle. Simultaneous epidural and radicular artery spread were observed under live fluoroscopy. The patient suffered no complications from the procedure.
This case demonstrates that the use of pencil-point (Whitacre) needles does not eliminate the risk of inadvertent arterial injection during cervical transforaminal epidurals. Further investigation is required to determine whether the incidence of inadvertent vascular injection is reduced with pencil-point needles compared with sharp-beveled needles.
病例报告及文献回顾。
报告首例使用无损伤性笔尖式穿刺针意外注射颈椎神经根动脉的病例。
颈椎椎间孔硬膜外皮质类固醇注射的罕见并发症导致脊髓和大脑梗死。最常假设的机制是意外将颗粒状皮质类固醇注入动脉，导致栓子形成和梗死。
回顾患者的病史和荧光透视成像。
一名 30 岁男性患有诊断明确的颈椎神经根病，接受了右侧 C6-C7 经椎间孔硬膜外皮质类固醇注射，使用 25 号 3.5 英寸 Whitacre 脊髓针。在实时荧光透视下观察到硬膜外和神经根动脉扩散。患者在手术过程中没有出现并发症。
该病例表明，笔尖式（Whitacre）针的使用并不能消除颈椎椎间孔硬膜外注射时针刺意外进入动脉的风险。需要进一步研究以确定与锐斜面针相比，笔尖式针是否能降低意外血管内注射的发生率。
