Expert: Ronald Levy, M.D. - 1/26/2008

Question
QUESTION: About 2 years ago I had steroid epidural injection and it went terribly wrong.  I know you won't answer questions regarding the actual procedure.  My questions are regarding the requirement an Anesthesiologist must meet to practice this type of a procedure? practice at a hospital?  The Anesthesiologist who did my epidural was not Board Certified and he is not a pain management specialist.  I looked him up on the internet and, as far as I could tell, he has gone to medical school and had interned in Anesthesiology.  He did a number of things wrong and I'm trying to find out whether or not he was qualified to do this procedure.

ANSWER: There is no such thing as interning in anesthesiology. He either completed a residency or not. As to who can perform an epidural steroid, the fact is, anyone can do it in their office but a hospital gives privileges to perform specific procedures and this is based on the training. So if this was done in a hospital, check with their medical board about the credentials of the physician. You do not need to be board certified or a pain specialist to do this procedure. The procedure itself is not difficult (it is the same one we do for pregnant women all the time). What requires training is knowing when it is appropriate to do the procedure. I would suggest starting at the hospital where he works and go from there.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston

---------- FOLLOW-UP ----------

QUESTION: I am sorry... you are correct I had forgotten the word..it was residency...and yes he did complete it.  Maybe you could answer this question, but if you can't, I would understand.  I went in for a C-7 injection; however, the anesthesiologist did not think there was enough room for the needle to fit, so he went to C4-C5 level using an 18 gauge needle.  When he gave me the epidural, he had me lean over a hospital tray table on wheels and put my feet down on the wheel bar.  When he inserted the needle, my feet kicked out and it shifted the table during the procedure.  He was using fluoroscopy, and in his report, he states that here was a prompt flow of subarachnoid fluid, he withdrew the needle into the epidural space and then he continued with the procedure.  When the table shifted I felt a jolt throughout the left side of my body that continued to last through the rest of the procedure.  When I felt the jolt, I asked him to discontinue the procedure, but he wouldn't.  I was sent home trembling and couldn't lower my shoulders for 2 days because of torn muscles and I had a excruciating headache for 13 days, completely incapacitating.  I was then partially paralyzed on the left side of my body for 98 days.  I have been doing some researching, but I'd like to hear what someone else has to say about it.  Assuming everything I've said is accurate, which it is, was everything you read done by the book?  If not, what should have been done differently.

Thanks

Answer
I am not a pain specialist and do not perform this procedure so my comments here probably are not that useful. You said he used fluoroscopy but normally that would be done with you lying face down on a bed. The epidural needle is about an 18G so that is correct (assuming he used an epidural needle). That he got into the subarachnoid space is unfortunate but not unheard of. The real problem comes when the needle hit the nerve and you had the jerk response. He should have aborted the procedure at that point and certainly because you asked him to abort it. The headache is a common complication from a subarchnoid placement of an epidrual needle but it should have been treated long before 13 days. That you were paralyzed is obviously bad but the fact that you recovered is good because transection of spinal cord generally does not repair (so you likely had a injury to the cord but not a tear).

Please do not take this as information towards pursuing legal action. You may or may not have grounds but without reviewing the chart, etc., I am working off of incomplete information. I would recommend talking to a pain specialist to get the information you need.

Good Luck,

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston