0:00

So this is, is a quick, quick example.

0:03

Now here, this is a, a patient

0:05

who had radiculopathy injection was done

0:08

and you, you have to know the flow pattern

0:10

of the injection in this patient.

0:11

Patient developed weakness, respiratory arrest

0:16

or vital signs were unstable.

0:17

Eight hour later scan was obtained

0:20

and the patient had a big, huge cerebellar in fog.

0:23

Uh, so you can see the cerebellar in fog.

0:25

So you have to know really the ate line, right lateral

0:28

to the ate lines are the vertebral artery.

0:30

So when you give the contrast under fluoroscopy, you have

0:33

to know the flow pattern of the contrast.

0:36

It should be at the level and going inferiorly.

0:38

But in this case, the contrast was going more superiorly.

0:41

That should not be happening.

0:43

It was lateral to the ate line.

0:45

It never crossed medial to the insulate line.

0:47

That's a very dangerous pattern of contrast.

0:50

And that's where when it entered into the vertebral artery

0:53

and caused spasm of the vertebral artery

0:55

and the patient had this big huge hemorrhagic infarct

0:58

and ultimately died in six days.

1:00

So this is improper technique used during the procedure.

1:04

So how do we avoid it?

1:06

Whenever you are, especially in the cervical spine,

1:08

make sure that you are in the epidural space

1:11

or whichever space you want to be.

1:13

We usually aspirate, we inject contrast

1:16

before we put in the medicine.

1:17

We if, especially in the cervical spine

1:19

and you are doing under fluoroscopy, make sure you do,

1:23

uh, subtracted images.

1:25

And here's an example.

1:26

You just do a, uh, straight, uh, image

1:29

and you can see a little bit of vascularization and,

1:33

and a good flow in that epidural transforaminal space.

1:37

So if you inject it, it can be catastrophic

1:39

because if you do a DSA image,

1:41

you can now see the anterior spinal artery in that patient.

1:45

And if you had injected in this, this would have had

1:49

devastating outcome for the patient.