4.5 Editorial Material

Beware the Wandering Needle: Inadvertent Intramedullary Injection During an Attempted Cervical Medial Branch Block

Journal

WORLD NEUROSURGERY
Volume 149, Issue -, Pages 169-170

Publisher

ELSEVIER SCIENCE INC
DOI: 10.1016/j.wneu.2021.02.107

Keywords

cervical spine; Facet joint; Lamina; Medial branch block; Spinal cord injry; Spinous process

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A 27-year-old man developed complications during an outpatient cervical medial branch block procedure, but after 48 hours of intensive care treatment, he experienced relief of neuropathic pain and almost complete recovery of neurological function.
A 27-year-old man developed sudden neck pain, severe quadriparesis, and right shoulder allodynia during an outpatient cervical medial branch block procedure. Cervical spine imaging revealed evidence of an interlaminar needle trajectory with abnormal signal in the right hemicord at the level of C4, consistent with intramedullary injection and contusion. Following a 48-hour stay in the intensive care unit, during which hemodynamic vasopressor support was administered to optimize spinal cord perfusion, the patient exhibited almost complete neurologic recovery with resolution of the neuropathic pain. He was eventually discharged home and underwent outpatient physical therapy for a mild residual right hemiparesis.

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