초록접수[미리보기]
| 21KF-037 |
Acute cervical myelopathy with hemiparesis after cervical epidural injection: A case report
Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea1, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea 2
Background>
Epidural steroid injection therapy is widely used as a non-surgical treatment for acute / chronic pain that occur in spinal disorders such as herniated discs and spinal stenosis. In addition, it is often used for pain management after spinal surgery. Side effects of epidural steroid injections can range from mild, such as headache and dysesthesia, hypotension, to severe, life-threatening conditions such as hematoma formation in the epidural space, nerve root injury, spinal cord injury, infections and cerebral infarction. Side effects that usually occur are almost temporary symptoms. Serious side effects with severe sequelae are rare, but fatal, and should always be noted.
Case report>
A 67-year-old female patient who suffered from neck pain and radiating pain in right arm, cervical epidural steroid injection was planned. Severe radiating pain and paresthesia occurred in right arm during the procedure under fluoroscopic guidance. The procedure was discontinued, but she experienced acute cervical myelopathy with hemiparesis. Her right leg was recovered spontaneously after 3 hours, but the neurologic symptoms and weakness at right arm was remained regardless of high dose of steroid therapy and gabapentin administration for 2 weeks. As a result of steroid therapy and rehabilitation therapy for about 6 months, the paresthesia and radiating pain in the right arm improved, but the myelopathy symptoms still persisted.
Conclusion>
In addition to degenerative changes, anatomical deformation of the epidural space such as epidural space adhesion, thickening and calcification of ligamentum flavum may occur during normal healing after surgery. The small amount of agent may have caused a volume effect on anatomically deformed epidural space, resulting in cord compression symptoms. Therefore, if the patient has symptoms that suggest myelopathy, such as weakness, even without the characteristic myelopathy findings on MRI, special care should be taken when deciding on the procedure.
Epidural steroid injection therapy is widely used as a non-surgical treatment for acute / chronic pain that occur in spinal disorders such as herniated discs and spinal stenosis. In addition, it is often used for pain management after spinal surgery. Side effects of epidural steroid injections can range from mild, such as headache and dysesthesia, hypotension, to severe, life-threatening conditions such as hematoma formation in the epidural space, nerve root injury, spinal cord injury, infections and cerebral infarction. Side effects that usually occur are almost temporary symptoms. Serious side effects with severe sequelae are rare, but fatal, and should always be noted.
Case report>
A 67-year-old female patient who suffered from neck pain and radiating pain in right arm, cervical epidural steroid injection was planned. Severe radiating pain and paresthesia occurred in right arm during the procedure under fluoroscopic guidance. The procedure was discontinued, but she experienced acute cervical myelopathy with hemiparesis. Her right leg was recovered spontaneously after 3 hours, but the neurologic symptoms and weakness at right arm was remained regardless of high dose of steroid therapy and gabapentin administration for 2 weeks. As a result of steroid therapy and rehabilitation therapy for about 6 months, the paresthesia and radiating pain in the right arm improved, but the myelopathy symptoms still persisted.
Conclusion>
In addition to degenerative changes, anatomical deformation of the epidural space such as epidural space adhesion, thickening and calcification of ligamentum flavum may occur during normal healing after surgery. The small amount of agent may have caused a volume effect on anatomically deformed epidural space, resulting in cord compression symptoms. Therefore, if the patient has symptoms that suggest myelopathy, such as weakness, even without the characteristic myelopathy findings on MRI, special care should be taken when deciding on the procedure.
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