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Inadvertent Injection of a Cervical Radicular Artery Using an Atraumatic Pencil-Point Needle

Smuck, Matthew MD*; Leung, Daniel DO

doi: 10.1097/BRS.0b013e3181f13417
Case Report

Study Design. Case report and review of the literature.

Objective. To report the first case of inadvertent injection of a cervical radicular artery using an atraumatic pencil-point needle.

Summary of Background Data. Rare 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.

Methods. Retrospective review of a patient's history and fluoroscopic imaging.

Results. A 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.

Conclusion. This 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.

The authors demonstrate that pencil-point (Whitacre) needles do not eliminate the risk of arterial injection during cervical transforaminal epidurals. Further investigation is required to determine whether its use reduces incidence of vascular injection.

*Department of Orthopaedic Surgery, Stanford University, Redwood City, CA

Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI.

Address correspondence and reprint requests to Matthew Smuck, MD, Department of Orthopaedic Surgery, Redwood City, CA 94062; E-mail:

Acknowledgment date: January 29, 2010; Revision date: June 23, 2010; Acceptance date: June 28, 2010.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

© 2011 Lippincott Williams & Wilkins, Inc.