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Unnecessary Cervical Epidural Injection in An Octogenarian
BACKGROUND: Epidural spine injections (ESI) have no documented long-term efficacy. Furthermore, cervical ESI uniquely risk intramedullary injections with resultant neurological deficits (e.g. monoplegia to quadriplegia), and intravascular vertebral injections (e.g. which potentially contribute to st...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Scientific Scholar
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6744805/ https://www.ncbi.nlm.nih.gov/pubmed/31528446 http://dx.doi.org/10.25259/SNI-197-2019 |
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author | Epstein, Nancy E. |
author_facet | Epstein, Nancy E. |
author_sort | Epstein, Nancy E. |
collection | PubMed |
description | BACKGROUND: Epidural spine injections (ESI) have no documented long-term efficacy. Furthermore, cervical ESI uniquely risk intramedullary injections with resultant neurological deficits (e.g. monoplegia to quadriplegia), and intravascular vertebral injections (e.g. which potentially contribute to stroke, brain stem infarction). CASE DESCRIPTION: A patient in his mid-eighties presented with 1 year’s duration of neck pain without any accompanying numbness, tingling or weakness in the upper or lower extremities. He had no radiculopathy, myelopathy, or neurological deficit. Two years earlier, the patient sustained a myocardial infarction (MI), requiring over 5 stents and a defibrillator. At the time of presentation, he was still on a baby ASA (81 mg/day), on anti-hypertensives, and cholesterol-lowering medications. His non-contrast cervical CT scan (patient had a pacemaker/defibrillator and could not have an MR) from the summer of 2018 showed no significant spinal cord or nerve root compression at any level. Nevertheless, he was subjected to two cervical epidural injections in the early fall; his baby ASA was stopped 5 days prior to each of these injections. Notably, this placed him at increased risk of MI and/or stroke. When he was seen by neurosurgery, without any neurological deficit or significant cervical radiographic findings, he was referred back to neurology for continued conservative management. CONCLUSIONS: Patients are increasingly subjected to epidural cervical spinal injections that have no documented long-term efficacy, and expose them to significant risks/complications. This 80+ year-old patient, without a neurological deficit or significant cervical CT-documented pathology, underwent 2 cervical ESI that unnecessarily exposed him to potential cardiac-stent related thrombosis (e.g. stopping ASA for 5 days-a bona-fide requirement for ESI to avoid acute epidural hematomas). |
format | Online Article Text |
id | pubmed-6744805 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Scientific Scholar |
record_format | MEDLINE/PubMed |
spelling | pubmed-67448052019-09-16 Unnecessary Cervical Epidural Injection in An Octogenarian Epstein, Nancy E. Surg Neurol Int Case Report BACKGROUND: Epidural spine injections (ESI) have no documented long-term efficacy. Furthermore, cervical ESI uniquely risk intramedullary injections with resultant neurological deficits (e.g. monoplegia to quadriplegia), and intravascular vertebral injections (e.g. which potentially contribute to stroke, brain stem infarction). CASE DESCRIPTION: A patient in his mid-eighties presented with 1 year’s duration of neck pain without any accompanying numbness, tingling or weakness in the upper or lower extremities. He had no radiculopathy, myelopathy, or neurological deficit. Two years earlier, the patient sustained a myocardial infarction (MI), requiring over 5 stents and a defibrillator. At the time of presentation, he was still on a baby ASA (81 mg/day), on anti-hypertensives, and cholesterol-lowering medications. His non-contrast cervical CT scan (patient had a pacemaker/defibrillator and could not have an MR) from the summer of 2018 showed no significant spinal cord or nerve root compression at any level. Nevertheless, he was subjected to two cervical epidural injections in the early fall; his baby ASA was stopped 5 days prior to each of these injections. Notably, this placed him at increased risk of MI and/or stroke. When he was seen by neurosurgery, without any neurological deficit or significant cervical radiographic findings, he was referred back to neurology for continued conservative management. CONCLUSIONS: Patients are increasingly subjected to epidural cervical spinal injections that have no documented long-term efficacy, and expose them to significant risks/complications. This 80+ year-old patient, without a neurological deficit or significant cervical CT-documented pathology, underwent 2 cervical ESI that unnecessarily exposed him to potential cardiac-stent related thrombosis (e.g. stopping ASA for 5 days-a bona-fide requirement for ESI to avoid acute epidural hematomas). Scientific Scholar 2019-06-19 /pmc/articles/PMC6744805/ /pubmed/31528446 http://dx.doi.org/10.25259/SNI-197-2019 Text en Copyright: © 2019 Surgical Neurology International http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. |
spellingShingle | Case Report Epstein, Nancy E. Unnecessary Cervical Epidural Injection in An Octogenarian |
title | Unnecessary Cervical Epidural Injection in An Octogenarian |
title_full | Unnecessary Cervical Epidural Injection in An Octogenarian |
title_fullStr | Unnecessary Cervical Epidural Injection in An Octogenarian |
title_full_unstemmed | Unnecessary Cervical Epidural Injection in An Octogenarian |
title_short | Unnecessary Cervical Epidural Injection in An Octogenarian |
title_sort | unnecessary cervical epidural injection in an octogenarian |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6744805/ https://www.ncbi.nlm.nih.gov/pubmed/31528446 http://dx.doi.org/10.25259/SNI-197-2019 |
work_keys_str_mv | AT epsteinnancye unnecessarycervicalepiduralinjectioninanoctogenarian |