{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T18:16:47Z","timestamp":1791310607007,"version":"4.3.1"},"reference-count":25,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2022,9,7]],"date-time":"2022-09-07T00:00:00Z","timestamp":1662508800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background: Cervical interlaminar epidural steroid injection (CIESI) is increasingly used as an interventional treatment for pain originating from the cervical spine. However, serious neurological complications may occur during CIESI because of direct nerve damage following inappropriate needle placement. Case report: A 35-year-old woman presented with posterior neck pain radiating to the left upper arm. Cervical magnetic resonance imaging (MRI) revealed left C6 nerve impingement. CIESI under fluoroscopic guidance was performed at another hospital using the left C5\/6 interlaminar approach. Immediately after the procedure, the patient experienced dizziness, decreased blood pressure, motor weakness in the left upper arm, and sensory loss. She visited our emergency department with postdural puncture headache (PDPH) that worsened after the procedure. Post-admission cervical MRI revealed intramedullary T2 high signal intensity and cord swelling from the C4\/5 to C6\/7 levels; thus, a diagnosis of spinal cord injury was made. The patient\u2019s PDPH spontaneously improved after 48 h. However, despite conservative treatment with steroids, the decrease in abduction of the left fifth finger and loss of sensation in the dorsum of the left hand persisted for up to 6 months after the procedure. As noticed in the follow-up MRI performed 6 months post-procedure, the T2 high signal intensity in the left intramedullary region had decreased compared to that observed previously; however, cord swelling persisted. Furthermore, left C7\/8 radiculopathy with acute denervation was confirmed by electromyography performed 6 months after the procedure. Conclusions: Fluoroscopy does not guarantee the prevention of spinal cord penetration during CIESI. Moreover, persistent neurological deficits may occur, particularly due to intrathecal perforation or drug administration during CIESI. Therefore, in accordance with the recommendations of the Multisociety Pain Workgroup, we recommend performing CIESI at the C6\/7 or C7\/T1 levels, where the epidural space is relatively large, rather than at the C5\/6 level or higher.<\/jats:p>","DOI":"10.3390\/medicina58091237","type":"journal-article","created":{"date-parts":[[2022,9,8]],"date-time":"2022-09-08T01:40:13Z","timestamp":1662601213000},"page":"1237","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Spinal Cord Injury and Postdural Puncture Headache following Cervical Interlaminar Epidural Steroid Injection: A Case Report"],"prefix":"10.3390","volume":"58","author":[{"given":"Hyung Joon","family":"Park","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, Gyeongchun Road 153, Guri 11923, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heezoo","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Guro Hospital, Gurodong Road 148, Guro-gu, Seoul 08308, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung Jin","family":"Jeong","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Guro Hospital, Gurodong Road 148, Guro-gu, Seoul 08308, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0187-0708","authenticated-orcid":false,"given":"Jae Hak","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Guro Hospital, Gurodong Road 148, Guro-gu, Seoul 08308, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0260-9886","authenticated-orcid":false,"given":"Sang Sik","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Guro Hospital, Gurodong Road 148, Guro-gu, Seoul 08308, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1557-3832","authenticated-orcid":false,"given":"Chung Hun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Korea University Medical Center, Guro Hospital, Gurodong Road 148, Guro-gu, Seoul 08308, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"199","DOI":"10.36076\/ppj.2010\/13\/199","article-title":"Analysis of the growth of epidural injections and costs in the Medicare population: A comparative evaluation of 1997, 2002, and 2006 data","volume":"13","author":"Manchikanti","year":"2010","journal-title":"Pain Physician"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.1016\/j.spinee.2015.08.068","article-title":"Cervical epidural steroid injections and spinal cord injuries","volume":"16","author":"Schreiber","year":"2015","journal-title":"Spine J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2144","DOI":"10.1097\/BRS.0b013e318145a360","article-title":"Complications of Interlaminar Cervical Epidural Steroid Injections","volume":"32","author":"Abbasi","year":"2007","journal-title":"Spine"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1249","DOI":"10.1097\/BRS.0b013e318053ec50","article-title":"Cervical Transforaminal Epidural Steroid Injections","volume":"32","author":"Scanlon","year":"2007","journal-title":"Spine"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1097\/PHM.0b013e3181e2d07c","article-title":"Complications of Cervical Transforaminal Epidural Steroid Injections","volume":"89","author":"Benny","year":"2010","journal-title":"Am. 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