Disclosures: Chong H. Kim: Nothing to disclose

Case Description: Epidural pneumorrhachis (air in the epidural space) is common following epidural injections using the loss of resistance technique. It is typically asymptomatic. However, we report an incidence of symptomatic epidural pneumorrhachis following a cervical epidural steroid injection.

Setting: Academic medical center, ambulatory surgery center.

Patient: A 50-year-old female, with right arm and neck pain due to cervical disc herniation was referred by her spine surgeon for a cervical epidural steroid injection. She underwent a C7-T1 interlaminar injection using the loss of resistance technique with saline under fluoroscopic guidance. After the loss of resistance was obtained, contrast confirmed the epidural space. A total of 4 mL, 0.5 mL of 4 mg/mL of dexamethasone, 0.5 mL of 1% lidocaine and 3 mL of preservative free saline, was injected without complication. The patient walked to the post procedure observation area without issues, then was discharged in stable condition 15 minutes later. She returned to the office 45 minutes after her discharge with severe pain, without other complaints or symptoms, in her thoracic spine, between the shoulder blades with minimal radiations to her chest that started 15 minutes prior.

Assessment/Results: CT of the C/T spine reviewed epidural pneumorrhachis. There were no other relevant findings. The exam was benign neurologically, other than for significant discomfort at rest as well as movement. The patient was discharged home with cyclobenzaprine. She experienced continued pain for ~36 hours at which time her symptoms improved and resolved.

Discussion: Loss of resistance is routinely performed with air or saline and epidural pneumorrhachis is common and typically asymptomatic. Systematic reviews have not found improvement in technique or decrease in complications with air versus saline. The treatment is supportive and symptoms improve with time.

Conclusion: We report a case of symptomatic epidural pneomorrhachis after a cervical epidural steroid injection.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/symptomatic-epidural-pneumorrhachis-after-cervical-epidural-steroid-injection/