A cervical anterior spinal artery syndrome after diagnostic blockade of the right C6-nerve root

TLDR

A 48‑year‑old man had severe neck pain radiating to his right arm. The authors performed a right C6 nerve root blockade with iotrolan, bupivacaine, and triamcinolone hexacetonide, and propose that the injection impaired perfusion of the anterior radicular artery, causing spinal cord infarction. MRI revealed a fatal cervical spinal cord infarction immediately after the C6 nerve root blockade, despite an initially unremarkable cervical spine scan.

Abstract

A 48-year-old man suffered from intractable neck pain irradiating to his right arm. Magnetic resonance imaging (MRI) of the cervical spine was unremarkable. A right-sided diagnostic C6-nerve root blockade was performed. Immediately following this seemingly uneventful procedure he developed a MRI-proven fatal cervical spinal cord infarction. We describe the blood supply of the cervical spinal cord and suggest that this infarction resulted from an impaired perfusion of the major feeding anterior radicular artery of the spinal cord, after local injection of iotrolan, bupivacaine, and triamcinolon-hexacetonide around the C6-nerve root on the right side.