• Matthew Smuck and Daniel Leung.
• Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA. msmuck@stanord.edu
• Spine. 2011 Feb 1;36(3):E220-3.

Study DesignCase report and review of the literature.ObjectiveTo report the first case of inadvertent injection of a cervical radicular artery using an atraumatic pencil-point needle.Summary Of Background DataRare complications from cervical transforaminal epidural corticosteroid injection have resulted in infarction of the spinal cord and brain. The most often-hypothesized mechanism is inadvertent intra-arterial injection of particulate corticosteroids with a resulting embolus and infarction.MethodsRetrospective review of a patient's history and fluoroscopic imaging.ResultsA 30-year-old man with a diagnosed cervical radiculopathy underwent a right C6-C7 transforaminal epidural corticosteroid injection, using a 25-gauge 3.5-inch Whitacre spinal needle. Simultaneous epidural and radicular artery spread were observed under live fluoroscopy. The patient suffered no complications from the procedure.ConclusionThis case demonstrates that the use of pencil-point (Whitacre) needles does not eliminate the risk of inadvertent arterial injection during cervical transforaminal epidurals. Further investigation is required to determine whether the incidence of inadvertent vascular injection is reduced with pencil-point needles compared with sharp-beveled needles.

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