Death during transforaminal epidural steroid nerve root block (C7) due to perforation of the left vertebral artery

Am J Forensic Med Pathol. 2003 Dec;24(4):351-5. doi: 10.1097/01.paf.0000097790.45455.45.


Treatment for individuals suffering from migraines and pain due to an inflammation or impingement of a nerve range from noninvasive methods such as massage, physical therapy, and medications to invasive methods such as epidural steroid injections and surgery. Each method of treatment has an associated level of risk. While minor to moderate complications from such procedures do occur, deaths are very rare. We report the first cited case of a death associated with the pain management procedure called nerve root block, also referred to as a transforaminal epidural steroid injection. We present the medical history and autopsy findings of a 44-year-old white female who died of massive cerebral edema secondary to the dissection of the left vertebral artery and subsequent thrombosis due to the perforation of that artery by a 25-gauge spinal needle during a C-7 nerve root block.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anesthetics, Local / administration & dosage
  • Anti-Inflammatory Agents / administration & dosage*
  • Brain Edema / etiology
  • Bupivacaine / administration & dosage
  • Fatal Outcome
  • Female
  • Humans
  • Injections, Epidural / adverse effects*
  • Methylprednisolone / administration & dosage*
  • Migraine Disorders / therapy
  • Neck Pain / therapy
  • Nerve Block / adverse effects*
  • Nerve Block / methods
  • Spinal Nerve Roots / drug effects
  • Thrombosis / etiology
  • Vertebral Artery / injuries*


  • Anesthetics, Local
  • Anti-Inflammatory Agents
  • Methylprednisolone
  • Bupivacaine