Introduction 

Chronic neck pain can be a debilitating condition with negative impacts on quality of life. A variety of etiologies exist for chronic neck pain, with one of the more common being cervical disc herniations and resultant radiculopathies. While definitive treatment may include surgical management, many patients' elective for more conservative therapies, such as a cervical epidural steroid injection. This procedure, while considered safe, has increased the risk for complications when the patient is sedated.   

Case Report 

Our case study highlights a healthy 26-year-old female patient who presented to the pain clinic with persistent right upper arm pain and allodynia four months after a cervical epidural steroid injection for cervical radiculopathy at outside hospital. The patient underwent this procedure under sedation and presented in the post-anesthesia care unit (PACU) with new-onset right arm weakness and debilitating pain that required intensive care unit (ICU) admission and high dose steroid therapy. Imaging at this time showed diffuse spinal cord edema and increased T2 signals in the cervicothoracic region. While her weakness subtly improved, her pronounced allodynia did not abate.  Repeat imaging four months later showed a cystic lesion in her right-sided spinal cord at the levels of C4-T2 with a maximum diameter of approximately 3mm and increased T2 signals in the corresponding area. This highlights the importance of avoiding sedation during cervical epidural steroid injections due to the risk of catastrophic adverse events with no verbal feedback. 

Discussion 

While an epidural steroid injection is considered a routine procedure, careful considerations must be made to reduce the risk of complications. Quantification of these events by the American Society of Anesthesiologists closed claim database suggests that the most common procedure-related event is direct needle trauma to a nerve or the spinal cord at 31%; and most of these events also occur in patients who receive general anesthesia or sedation at 67%.