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Iatrogenic neurological injury after radiofrequency ablation and epidural steroid injections: illustrative cases

BACKGROUND: Neck pain is often chronic and disabling. Cervical facet joint injections and epidural steroid injections are frequently used to manage chronic neck pain and cervicogenic headaches. While minimal side effects are commonly associated with these treatments, severe complications are exceedi...

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Autores principales: Shields, Lisa B. E., Iyer, Vasudeva G., Zhang, Yi Ping, Shields, Christopher B.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Association of Neurological Surgeons 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9245771/
https://www.ncbi.nlm.nih.gov/pubmed/35854838
http://dx.doi.org/10.3171/CASE2148
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author Shields, Lisa B. E.
Iyer, Vasudeva G.
Zhang, Yi Ping
Shields, Christopher B.
author_facet Shields, Lisa B. E.
Iyer, Vasudeva G.
Zhang, Yi Ping
Shields, Christopher B.
author_sort Shields, Lisa B. E.
collection PubMed
description BACKGROUND: Neck pain is often chronic and disabling. Cervical facet joint injections and epidural steroid injections are frequently used to manage chronic neck pain and cervicogenic headaches. While minimal side effects are commonly associated with these treatments, severe complications are exceedingly rare. OBSERVATIONS: The authors report 4 cases of iatrogenic neurological injury after radiofrequency ablation (RFA) and epidural steroid injections. One patient experienced left shoulder, scapular, and arm pain with left arm and hand weakness that developed immediately after RFA for chronic neck pain. Electromyography/nerve conduction velocity (EMG/NCV) studies confirmed denervation changes in the left C8–T1 distribution. Three patients complained of numbness and weakness of the hands immediately after an interlaminar cervical epidural block. One of these patients underwent EMG/NCV that confirmed denervation changes occurring in the left C8–T1 distribution. LESSONS: Spine surgeons and pain management specialists should be aware of neurological injuries that may occur after cervical RFA and epidural steroid injections, especially after a multilevel cervical procedure and with severe cervical spinal stenosis. EMG/NCV studies plays an important role in detecting and localizing neurological injury and in differentiating from conditions that mimic cervical root injuries, including brachial plexus trauma due to positioning and Parsonage-Turner syndrome.
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spelling pubmed-92457712022-07-18 Iatrogenic neurological injury after radiofrequency ablation and epidural steroid injections: illustrative cases Shields, Lisa B. E. Iyer, Vasudeva G. Zhang, Yi Ping Shields, Christopher B. J Neurosurg Case Lessons Case Lesson BACKGROUND: Neck pain is often chronic and disabling. Cervical facet joint injections and epidural steroid injections are frequently used to manage chronic neck pain and cervicogenic headaches. While minimal side effects are commonly associated with these treatments, severe complications are exceedingly rare. OBSERVATIONS: The authors report 4 cases of iatrogenic neurological injury after radiofrequency ablation (RFA) and epidural steroid injections. One patient experienced left shoulder, scapular, and arm pain with left arm and hand weakness that developed immediately after RFA for chronic neck pain. Electromyography/nerve conduction velocity (EMG/NCV) studies confirmed denervation changes in the left C8–T1 distribution. Three patients complained of numbness and weakness of the hands immediately after an interlaminar cervical epidural block. One of these patients underwent EMG/NCV that confirmed denervation changes occurring in the left C8–T1 distribution. LESSONS: Spine surgeons and pain management specialists should be aware of neurological injuries that may occur after cervical RFA and epidural steroid injections, especially after a multilevel cervical procedure and with severe cervical spinal stenosis. EMG/NCV studies plays an important role in detecting and localizing neurological injury and in differentiating from conditions that mimic cervical root injuries, including brachial plexus trauma due to positioning and Parsonage-Turner syndrome. American Association of Neurological Surgeons 2021-05-10 /pmc/articles/PMC9245771/ /pubmed/35854838 http://dx.doi.org/10.3171/CASE2148 Text en © 2021 The authors https://creativecommons.org/licenses/by-nc-nd/4.0/CC BY-NC-ND 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) ).
spellingShingle Case Lesson
Shields, Lisa B. E.
Iyer, Vasudeva G.
Zhang, Yi Ping
Shields, Christopher B.
Iatrogenic neurological injury after radiofrequency ablation and epidural steroid injections: illustrative cases
title Iatrogenic neurological injury after radiofrequency ablation and epidural steroid injections: illustrative cases
title_full Iatrogenic neurological injury after radiofrequency ablation and epidural steroid injections: illustrative cases
title_fullStr Iatrogenic neurological injury after radiofrequency ablation and epidural steroid injections: illustrative cases
title_full_unstemmed Iatrogenic neurological injury after radiofrequency ablation and epidural steroid injections: illustrative cases
title_short Iatrogenic neurological injury after radiofrequency ablation and epidural steroid injections: illustrative cases
title_sort iatrogenic neurological injury after radiofrequency ablation and epidural steroid injections: illustrative cases
topic Case Lesson
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9245771/
https://www.ncbi.nlm.nih.gov/pubmed/35854838
http://dx.doi.org/10.3171/CASE2148
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