Case Report

A Whitacre-Type Spinal Needle Does Not Prevent Intravascular Injection During Cervical Nerve Root Injections

Authors: Kenneth D. Candido, MD, Ramsis F. Ghaly, MD, FACS, Sara Mackerley, DO, Nebojsa Nick Knezevic, MD, PhD

Abstract

We present a case of intravascular injection in a 41-year-old female during cervical selective nerve root injection using a 22-gauge 3.5-inch Whitacre-type pencil-point subarachnoid needle with a curve placed at the distal tip positioned using continual live fluoroscopic guidance. After negative aspiration for blood and cerebrospinal fluid and no elicited paresthesias during the procedure, 1 mL of contrast was injected. Initial imaging at C6 captured the outline of the nerve root along with a significant amount of transient vascular runoff. This case report demonstrates that Whitacre-type spinal needles do not prevent vascular injection, and that aspiration of the needle is not a reliable sign of intravascular injection.


Key Points


* This case report demonstrates that Whitacre-type spinal needles do not prevent intravascular injection.


* An aspiration test is not always a reliable sign of intravascular injection.


* It is important to use continuous live fluoroscopy or digital subtraction angiography during interventional pain procedures.

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