side effects and complications
Because of the proximity to the cervical spinal canal, accidental
RF lesioning of the neuraxial structures at this level can result
in significant neurologic dysfunction, including quadriparesis.
Unintentional lesioning of the phrenic nerve can result in dia-
phragmatic paralysis and respiratory insufficiency. Inadvertent
lesioning of the recurrent laryngeal nerve can result in pro-
longed or permanent hoarseness. A permanent Horner syn-
drome can occur if the superior cervical sympathetic ganglion
is damaged during the procedure. Pneumothorax is a distinct
possibility, especially on the right side and with lesioning at the
T1 level. The incidence of all the above complications can be
decreased with careful use of trial stimulation and fluoroscopic
guidance. The anatomic region in this area is highly vascular,
increasing the risk for local and systemic anesthetic toxicity as
well as hematoma formation.