{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T13:03:21Z","timestamp":1789995801239,"version":"4.0.1"},"reference-count":9,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Cervical epidural and nerve root blocks effectively manage radicular pain but pose risks of severe neurologic complications, including acute myelopathy. Although vascular embolization of particulate steroids is often implicated in these events, direct mechanical spinal cord injury remains an underrecognized etiology. Identifying the true pathophysiologic mechanism is essential to prevent permanent neurological deficits. We retrospectively reviewed four patients who developed acute spinal cord injuries immediately following cervical nerve blocks or targeted acupuncture. We analyzed clinical presentations, intraprocedural events, and longitudinal magnetic resonance imaging (MRI) findings to elucidate the underlying mechanism of injury. All patients reported an instantaneous, excruciating \u201celectric shock-like\u201d sensation during needle insertion, followed immediately by severe motor weakness and paresthesia. MRI consistently revealed focal, central T2-weighted high signal intensities strictly localized within the spinal cord parenchyma. Unlike typical vascular infarctions following specific arterial territories, these findings strongly correlate with the physical trajectory of a direct needle puncture. The pathognomonic intraprocedural electric shock sensation and the central localization of MRI lesions strongly suggest direct mechanical needle injury as a primary cause of these catastrophic complications. Immediate cessation of needle advancement upon patient report of a shock-like sensation is critical to prevent irreversible spinal cord damage.<\/jats:p>","DOI":"10.4103\/jcvjs.jcvjs_92_26","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T17:00:31Z","timestamp":1789750831000},"page":"570-573","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Direct spinal cord injury during cervical epidural and nerve root blocks: A case series and pathophysiological reevaluation"],"prefix":"10.4103","volume":"17","author":[{"given":"Sung Jin","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Dankook University Hospital, Dankook University College of Medicine, Cheonan, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young Jin","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Dankook University Hospital, Dankook University College of Medicine, Cheonan, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"In Ho","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Dankook University Hospital, Dankook University College of Medicine, Cheonan, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"R1-20260921","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1053\/apmr.2000.7166","article-title":"Complications of fluoroscopically guided transforaminal lumbar epidural injections","volume":"81","author":"Botwin","year":"2000","journal-title":"Arch Phys Med Rehabil"},{"key":"R2-20260921","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/S1529-9430(01)00159-0","article-title":"Paraplegia after lumbosacral nerve root block: Report of three cases","volume":"2","author":"Houten","year":"2002","journal-title":"Spine J"},{"key":"R3-20260921","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1016\/j.rehab.2010.08.029","article-title":"A rare case of paraplegia complicating a lumbar epidural infiltration","volume":"53","author":"Thefenne","year":"2010","journal-title":"Ann Phys Rehabil Med"},{"key":"R4-20260921","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1159\/000455069","article-title":"Spinal cord infarction after cervical transforaminal epidural steroid injection: Case report and literature review","volume":"9","author":"Moon","year":"2017","journal-title":"Case Rep Neurol"},{"key":"R5-20260921","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1097\/ALN.0000000000000614","article-title":"Safeguards to prevent neurologic complications after epidural steroid injections: consensus opinions from a multidisciplinary working group and national organizations","volume":"122","author":"Rathmell","year":"2015","journal-title":"Anesthesiology"},{"issue":"Suppl 1","key":"R6-20260921","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1038\/sc.2014.180","article-title":"Spinal cord injury complicating a thoracolumbar selective nerve root block in a deformed spine: neurological and functional outcome","volume":"53","author":"Kumar","year":"2015","journal-title":"Spinal Cord"},{"key":"R7-20260921","doi-asserted-by":"crossref","first-page":"e18299","DOI":"10.1097\/MD.0000000000018299","article-title":"Acute cervical myelopathy with quadriparesis after cervical transforaminal epidural steroid injection: A case report","volume":"98","author":"Yang","year":"2019","journal-title":"Medicine (Baltimore)"},{"key":"R8-20260921","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.pain.2005.05.030","article-title":"Anatomy of the cervical intervertebral foramina: vulnerable arteries and ischemic neurologic injuries after transforaminal epidural injections","volume":"117","author":"Huntoon","year":"2005","journal-title":"Pain"},{"key":"R9-20260921","doi-asserted-by":"crossref","first-page":"E266","DOI":"10.1097\/01.brs.0000162401.47054.00","article-title":"Spinal cord infarction following cervical transforaminal epidural injection: a case report","volume":"30","author":"Ludwig","journal-title":"Spine (Phila Pa 1976)"}],"container-title":["Journal of Craniovertebral Junction and Spine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/jcvjs.jcvjs_92_26","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T12:12:18Z","timestamp":1789992738000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/jcvjs.jcvjs_92_26"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":9,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/jcvjs.jcvjs_92_26","relation":{},"ISSN":["0974-8237","0976-9285"],"issn-type":[{"value":"0974-8237","type":"print"},{"value":"0976-9285","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]},"assertion":[{"value":"2026-04-27","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-01","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}