Emanuel Medical Center, 825 Delbon Ave., Turlock, CA 95382, USA.
Pain Physician. 2012 Mar-Apr;15(2):147-52.
Epidural steroid injection is a common treatment for the management of pain in a wide variety of patients. It is generally well tolerated and perceived to have few side effects, with a low risk of serious complications. Only a handful of reports exist that describe life-threatening complications such as subdural hematoma, respiratory depression, vasovagal response, and pneumocephalus. This is a case report of a 67-year-old woman with a relatively unremarkable past medical history, other than rheumatoid arthritis, osteoarthritis, and hypertension, who suffered from chronic neck pain treated with cervical epidural steroid injection at the C6-C7 level. She went into immediate cardiopulmonary arrest following the injection. She was brought to the emergency department by ambulance and resuscitated, and was found to have pneumocephalus. Ultimately, she made a relatively full recovery over the following weeks. Cardiopulmonary arrest is a rare but potentially deadly side effect of epidural steroid injection. To the best of our knowledge, this is the first report of such an arrest following a steroid injection in the cervical spinal region. There are several possible mechanisms for the immediate arrest, including cardioacceleratory center blockade, severe vasovagal response, iatrogenic pneumocephalus, and involvement of the phrenic nerve followed by apnea. Our conclusion in this case is that the most likely scenario was injection of the C6-C7 level led to a blockade of the cardiac accelerator fibers located just below in the T1-T4 spinal level, causing a sympathetic blockade and profound bradycardia, leading to cardiopulmonary arrest.
硬膜外类固醇注射是治疗各种疼痛的常用方法。它通常耐受性良好，被认为副作用较少，严重并发症的风险低。只有少数几篇报告描述了危及生命的并发症，如硬膜下血肿、呼吸抑制、血管迷走神经性反应和空气栓塞。这是一例 67 岁女性的病例报告，她既往病史相对无明显异常，除了类风湿关节炎、骨关节炎和高血压外，还患有慢性颈部疼痛，在 C6-C7 水平接受了颈椎硬膜外类固醇注射治疗。注射后，她立即发生心肺骤停。她被救护车送往急诊室进行复苏，并发现有空气栓塞。最终，她在接下来的几周内相对完全康复。心肺骤停是硬膜外类固醇注射的罕见但潜在致命的副作用。据我们所知，这是首例颈椎脊柱区域类固醇注射后发生此类骤停的报告。立即发生骤停的可能机制包括：加速心率中枢阻滞、严重的血管迷走神经性反应、医源性空气栓塞以及膈神经受累和随后的呼吸暂停。在这种情况下，我们的结论是最有可能的情况是 C6-C7 水平的注射导致位于 T1-T4 脊髓水平以下的心脏加速纤维阻滞，引起交感神经阻滞和严重心动过缓，导致心肺骤停。
