Vascular uptake of contrast despite negative aspiration in interlaminar cervical epidural injection.

Pain Physician Vol. 9, No. 3, 2006 To the Editor: We report a case of intravascular uptake of contrast during interlaminar cervical epidural steroid injection (ESI) despite absence of spontaneous blood backflow through the needle hub and negative aspiration for blood. A 67-year-old female patient with neck pain and radiation of pain into her right shoulder and upper arm was referred to our pain clinic for cervical ESI. After obtaining informed written consent, the patient was placed in the prone position. The neck was cleaned and draped in a sterile fashion. The C6C7 interspace was identified and confirmed using fluoroscopy in the anteroposterior view. After skin infiltration with 1% lidocaine, an 18-Gauge Tuohy needle was used to locate the epidural space by the hanging drop method. There was no spontaneous blood flow back into the needle hub. Aspiration was negative for cerebrospinal fluid or blood. Contrast was injected under real-time fluoroscopy and vascular uptake was demonstrated. The Tuohy needle was retracted, cleared of blood and repositioned. Epidural space was located again using the hanging drop method. There was no backflow of blood and aspiration was negative for blood. Vascular uptake was again observed with repeat injection of contrast. The Tuohy needle was removed and injection was performed at the C7-T1 interspace. There was no backflow of blood into the needle hub and aspiration was negative. Contrast was injected and confirmed epidural space location. Triamcinolone 40mg in 4 ml of normal saline was injected without complications. The patient tolerated the procedure well. Cervical epidural injections (ESIs) are performed for treatment of neck pain or upper limb radicular pain secondary to cervical disc pathology. Interlaminar Vascular Uptake Of Contrast Despite Negative Aspiration In Interlaminar Cervical Epidural Injection