Hodges S D, Castleberg R L, Miller T, Ward R, Thornburg C
Chattanooga Orthopaedic Group, Foundation for Research, Tennessee, USA.
Spine (Phila Pa 1976). 1998 Oct 1;23(19):2137-42; discussion 2141-2. doi: 10.1097/00007632-199810010-00020.
Intrinsic cervical spinal cord damage represents the serious and permanent complications that can occur if cervical epidural steroid injections are administered while the patient is sedated. Two case reports are presented.
To draw attention to the dangerous consequences that can arise from sedating a patient before administering a cervical epidural steroid injection.
Reported complications of cervical epidural steroid injections have been minor and infrequent. No reports of intrinsic cervical cord damage could be found in a comprehensive English language literature search.
Two case reports of permanent intrinsic cervical cord damage in patients 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 patient had herniated nucleus pulposus before they received cervical epidural steroid injections and intrinsic cord damage on postinjection magnetic resonance images.
Both patients developed increased pain and neurologic symptoms within 24 hours of injection. To date, these symptoms appear to be permanent. However, Patient 1 had pain relief in her right arm and shoulder after undergoing a microdiscectomy, but pain was still persistent in her left leg, and she has developed a positive Lhermitte's sign.
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 patient to experience the expected pain and paresthesias at the time of spinal cord irritation. Therefore, the authors conclude that the patient should be fully awake during the administration of cervical epidural steroid injections, with only local anesthetic in the skin used for analgesia.
如果在患者镇静状态下进行颈椎硬膜外类固醇注射，可能会出现严重且永久性的并发症，即颈椎脊髓内在损伤。本文报告了两例病例。
提醒注意在进行颈椎硬膜外类固醇注射前对患者进行镇静可能产生的危险后果。
已报道的颈椎硬膜外类固醇注射并发症轻微且不常见。在全面的英文文献检索中未发现颈椎脊髓内在损伤的报告。
报告两例在静脉镇静下接受颈椎硬膜外类固醇注射后出现永久性颈椎脊髓内在损伤的病例。在颈椎硬膜外类固醇注射前后均进行了磁共振成像检查。每位患者在接受颈椎硬膜外类固醇注射前均有椎间盘突出，注射后磁共振图像显示脊髓内在损伤。
两名患者在注射后24小时内疼痛和神经症状均加重。迄今为止，这些症状似乎是永久性的。然而，患者1在接受显微椎间盘切除术后右臂和肩部疼痛缓解，但左腿仍持续疼痛，且出现了阳性莱尔米特征。
这些病例报告表明，在进行颈椎硬膜外类固醇注射时，透视引导并不能确保或防止鞘内穿孔或脊髓穿刺。此外，尽管颈椎硬膜外类固醇注射期间多次使用静脉镇静且未报告并发症，但在这两例中，静脉镇静似乎导致患者在脊髓受刺激时无法体验到预期的疼痛和感觉异常。因此，作者得出结论，在进行颈椎硬膜外类固醇注射时患者应完全清醒，仅在皮肤使用局部麻醉剂进行镇痛。
