Abstract
We report about a patient in whom transient tetraplegia with intact proprioception occurred immediately after infiltration of a facet joint at the C6 level guided by anatomical landmarks. After positioning the patient supine and applying atropine and oxygen, respiration and circulation were stable and all symptoms resolved within the next 30 min. The type of neurological pattern and the course of disease suggest an inadvertent injection into a cervical radicular artery that reinforces the anterior spinal artery. This complication is potentially serious and may be permanently disabling or life threatening. It should be considered by any clinician performing "blind" zygapophysial joint injections in the cervical spine. Using imaging guidance should help prevent this type of complication.
MeSH terms
-
Adult
-
Anesthetics, Local / adverse effects*
-
Arteries / injuries
-
Atropine / therapeutic use
-
Bradycardia / chemically induced
-
Bradycardia / physiopathology
-
Cervical Vertebrae / physiopathology
-
Cervical Vertebrae / surgery*
-
Chronic Disease / therapy
-
Diagnostic Imaging / standards
-
Female
-
Humans
-
Hypotension / chemically induced
-
Hypotension / physiopathology
-
Iatrogenic Disease / prevention & control
-
Injections / adverse effects
-
Lidocaine / adverse effects
-
Monitoring, Physiologic / standards
-
Muscarinic Antagonists / therapeutic use
-
Neck Pain / drug therapy*
-
Neck Pain / etiology
-
Neck Pain / physiopathology
-
Oxygen / therapeutic use
-
Postoperative Complications / etiology
-
Postoperative Complications / physiopathology
-
Postoperative Complications / prevention & control
-
Quadriplegia / chemically induced*
-
Quadriplegia / physiopathology
-
Spinal Cord / blood supply
-
Spinal Cord / drug effects*
-
Spinal Cord / physiopathology
-
Zygapophyseal Joint / innervation
-
Zygapophyseal Joint / physiopathology
-
Zygapophyseal Joint / surgery*
Substances
-
Anesthetics, Local
-
Muscarinic Antagonists
-
Atropine
-
Lidocaine
-
Oxygen