A 46-year-old woman received one cervical epidural injection for the management of her neck and shoulder pain. The patient was placed in the prone position without sedation. By using the "loss of resistance to injection of air" technique, the epidural space was identified at the level of C7-T1 inter-laminar space. After needle placement was confirmed by biplanar fluoroscopy and contrast dye, mixture composed of 20 mg of triamcinolone acetonide and 0.125% chirocaine (6.5 ml total volume) was injected. The patient reported no reaction or signs of spinal cord irritation during needle placement attempt. She was developed both low extremity motor weakness and the repeated MRI of the cervical spine indicated right focal cervical myelopathy. It is unknown whether the neurologic injury sustained by patient was the result of spinal cord penetration by the needle, adverse effects from neural tissue exposure to the injected drug, or a combination of both factors.