Complications of cervical epidural steroid injection

Patients with cervical pain who fail to improve with non-interventional conservative treatments may experience analgesia with cervical epidural steroid injections (CESIs). However, due to the complexity and considerable variability in cervical spinal anatomy, severe complications may occur and interventionalists must observe proper precautions to safely perform this delicate procedure. There are two approaches for injection of steroid in the cervical epidural space, namely the interlaminar CESI approach and the transforaminal CESI approach. Epidural injection of local anesthetics alone, or as a diluent during steroid injection, is common in practice. Trauma to the spinal cord can be caused by aberrant needle placement through the thecal sac and into the spinal cord itself. The subdural space is a potential space between the subarachnoid and epidural spaces. Injection of a very small amount of contrast material will appear like a thin, straight line at multiple levels.