Poster 348 Transient Hemiplegia After Cervical Facet Joint Injection Given Under Sedation for Cervical Spondylosis: A Case Report

Patients or Programs: A 52-year-old woman with chronic neck pain. Program Description: The patient received a cervical facet injection at C5-6 and C6-7 bilaterally while under sedation with propofol (Diprivan) and fluoroscopic guidance. After the procedure, she had right-sided hemiplegia and hemisensory loss. Computerized tomography showed air within the spinal cord near the level injected on the right side. The patient subsequently was transferred from an outside facility to our rehabilitation hospital. On admission, a neurologic examination of the arms showed paralysis of the right hand and arm. Strength of the right leg was 1/5. Pinprick and temperature sensation of the right hand and left leg was decreased while proprioception was intact. Setting: Inpatient rehabilitation center. Results: 3 days after the procedure, she regained 2/5 strength in the right leg dorsiflexion and plantarflexion along with improved but still impaired pinprick and light touch sensation in the left leg. On day 6, she regained 2/5 strength of her extrinsic finger flexors and extensors. At day 20, her right extrinsic finger flexors and extensors, wrist extensors, and elbow flexors and extensors had 3/5 strength. She also had 3/5 strength in right hip flexors, knee extensors, and ankle dorsiflexion and plantarflexion. Pinprick sensation remained impaired on the right arm and left leg. Discussion: Injections into the cervical facet joints are accompanied by considerable risk and should be performed under fluoroscopic guidance. Despite use of fluoroscopy, an injection was given into the spinal cord instead of the intended target. This outcome emphasizes the importance of careful technique for performance of cervical fact injections. There is additional risk if the patient is sedated because he or she is unable to give feedback in the event of accidental entry into the spinal cord. Conclusions: Spinal injections should not be performed with the patient under sedation.