921 - Blunt Injury to the Spinal Cord After Epidural Steroid Injection: A Case Report

Case Diagnosis: Incomplete tetraplegia secondary to blunt injury to spinal cord after epidural steroid injection



Case Description: An 80-year-old female with a history of cervical stenosis and left neck pain presents with incomplete tetraplegia after a C7-T1 epidural steroid injection (ESI). Immediately after the injection, patient began to experience anxiety and chest tightness for approximately 15 minutes after which she had bilateral upper and lower extremity weakness with associated numbness and tingling. MRI cervical spine showed stenosis at C4-5, moderate stenosis at C5-6 and C6-7 with slight cord compression, with no hematoma. The patient also reported loss of sensation in anal region and had episodes of urinary incontinence. Neurology was consulted and extrapolated that the patient's weakness was caused by blunt injury to the spinal cord from the steroid injection. The patient began to gain strength rapidly and continued to make functional gains in acute rehab.

Discussions: Blunt injuries are the most common type of spinal cord injury (SCI), often secondary to motor vehicle accident or falls. Cervical SCI represents an even smaller subset, carrying high morbidity and mortality. SCI after ESI is quite rare with initial case reports published in the early 2000s. We present a case of iatrogenic SCI after ESI due to direct blunt injury by needle, with no resulting hematoma. As the popularity of interventional pain management continues to rise, this case represents the typical acute clinical and neurological findings after injury. Acute inpatient rehabilitation continues to demonstrates significant benefit for these patients.

Conclusions: This case highlights that neurological deficits after an epidural steroid injection, although rare, can present without radiographic evidence.