Right hemidiaphragmatic paralysis after cervical transforaminal epidural steroid injection: illustrative case.
APN = accessory phrenic nerve
CT = computed tomography
CTFESI
CTFESI = cervical transforaminal epidural steroid injection
IgG = immunoglobulin G
NA = neuralgic amyotrophy
cervical transforaminal epidural steroid injection
hemidiaphragmatic paralysis
Journal
Journal of neurosurgery. Case lessons
ISSN: 2694-1902
Titre abrégé: J Neurosurg Case Lessons
Pays: United States
ID NLM: 9918227275606676
Informations de publication
Date de publication:
10 May 2021
10 May 2021
Historique:
received:
13
11
2020
accepted:
15
02
2021
entrez:
20
7
2022
pubmed:
10
5
2021
medline:
10
5
2021
Statut:
epublish
Résumé
Cervical radiculopathy is a common cause of neck pain, with radiation into the upper extremity in a dermatomal pattern. Corticosteroid injection is a conservative management option with a low risk of major adverse events. No reviewed literature or case reports have implicated phrenic nerve injury secondary to cervical transforaminal epidural steroid injection (CTFESI). A 45-year-old man with severe right C6 radiculopathy secondary to a large right-sided C5-6 herniated intervertebral disc presented to the pain management clinic, where he received a right-sided C6 CTFESI. An hour after injection, the patient experienced shortness of breath, which was found to be caused by right diaphragmatic paralysis. The patient underwent a C5-6 anterior cervical discectomy and fusion, which provided complete relief of his radicular symptoms. However, the right hemidiaphragmatic paralysis remained at the 1-year postoperative visit. Thorough literature review showed no established explanations for phrenic nerve injury after CTFESI. In this study, the authors explored the suspected mechanisms of possible injury to the phrenic nerve. Epidural corticosteroid injection is considered to be a safe option for conservative management of cervical radiculopathy. This study unveiled a unique and important adverse event that should be considered before a patient receives CTFESI.
Sections du résumé
BACKGROUND
BACKGROUND
Cervical radiculopathy is a common cause of neck pain, with radiation into the upper extremity in a dermatomal pattern. Corticosteroid injection is a conservative management option with a low risk of major adverse events. No reviewed literature or case reports have implicated phrenic nerve injury secondary to cervical transforaminal epidural steroid injection (CTFESI).
OBSERVATIONS
METHODS
A 45-year-old man with severe right C6 radiculopathy secondary to a large right-sided C5-6 herniated intervertebral disc presented to the pain management clinic, where he received a right-sided C6 CTFESI. An hour after injection, the patient experienced shortness of breath, which was found to be caused by right diaphragmatic paralysis. The patient underwent a C5-6 anterior cervical discectomy and fusion, which provided complete relief of his radicular symptoms. However, the right hemidiaphragmatic paralysis remained at the 1-year postoperative visit.
LESSONS
CONCLUSIONS
Thorough literature review showed no established explanations for phrenic nerve injury after CTFESI. In this study, the authors explored the suspected mechanisms of possible injury to the phrenic nerve. Epidural corticosteroid injection is considered to be a safe option for conservative management of cervical radiculopathy. This study unveiled a unique and important adverse event that should be considered before a patient receives CTFESI.
Identifiants
pubmed: 35854830
doi: 10.3171/CASE20113
pii: CASE20113
pmc: PMC9245767
doi:
Types de publication
Case Reports
Langues
eng
Pagination
CASE20113Informations de copyright
© 2021 The authors.
Déclaration de conflit d'intérêts
Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
Références
Mayo Clin Proc. 1994 Aug;69(8):774-8
pubmed: 8035635
Reg Anesth Pain Med. 2006 May-Jun;31(3):282-5
pubmed: 16701197
Arch Bronconeumol. 2010 Jul;46(7):390-2
pubmed: 19879033
J Neurol. 2007 Jun;254(6):695-704
pubmed: 17446996
Am Rev Respir Dis. 1993 Jan;147(1):66-71
pubmed: 8420434
Arch Neurol. 1972 Aug;27(2):109-17
pubmed: 4339239
Pain Med. 2017 Sep 1;18(9):1817-1818
pubmed: 28926652
Ann Thorac Surg. 2006 Nov;82(5):1870-5
pubmed: 17062263
Brain. 1994 Apr;117 ( Pt 2):325-35
pubmed: 8186959
Pain Med. 2016 Feb;17(2):239-49
pubmed: 26593277
Ann Am Thorac Soc. 2016 Dec;13(12):2261-2265
pubmed: 27632573
Spine (Phila Pa 1976). 2005 May 15;30(10):E266-8
pubmed: 15897816
HSS J. 2010 Sep;6(2):199-205
pubmed: 21886536
Surg Neurol Int. 2013 Mar 22;4(Suppl 2):S74-93
pubmed: 23646278
Radiology. 2016 Jun;279(3):731-40
pubmed: 26761719
Clin Anat. 2017 Nov;30(8):1077-1082
pubmed: 28726261
Eur Respir J. 1999 Feb;13(2):379-84
pubmed: 10065685
Curr Rev Musculoskelet Med. 2016 Sep;9(3):272-80
pubmed: 27250042
Ann Vasc Surg. 2020 Jan;62:70-75
pubmed: 31207398
Skeletal Radiol. 2015 Feb;44(2):149-55
pubmed: 25394547
Phys Med Rehabil Clin N Am. 2018 Feb;29(1):155-169
pubmed: 29173660
Radiology. 2016 Dec;281(3):669-688
pubmed: 27870618
Acta Radiol Open. 2019 Mar 12;8(3):2058460119834688
pubmed: 30886742
Ann Thorac Surg. 2011 Jul;92(1):349-51
pubmed: 21718875
Pain. 2001 Apr;91(3):397-399
pubmed: 11275398