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Pecorari IL, Agarwal V. Medical malpractice and epidural hematomas: a retrospective analysis of 101 cases in the United States. Ann Med Surg (Lond) 2024; 86:1873-1880. [PMID: 38576915 PMCID: PMC10990362 DOI: 10.1097/ms9.0000000000001581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/22/2023] [Indexed: 04/06/2024] Open
Abstract
Background Neurosurgeons face particularly high rates of litigation compared to physicians in other fields. Malpractice claims are commonly seen after mismanagement of life-threatening medical emergencies, such as epidural haematomas. Due to the lack of legal analysis pertaining to this condition, the aim of this study is to identify risk factors associated with litigation in cases relating to the diagnosis and treatment of epidural haematomas. Materials and methods Westlaw Edge, an online database, was used to analyze malpractice cases related to epidural haematomas between 1986 and 2022. Information regarding plaintiff demographics, defendant specialty, reason for litigation, trial outcomes, and payouts for verdicts and settlements were recorded. Comparative analysis between cases that returned a jury verdict in favour of the plaintiff versus defendant was completed. Results A total of 101 cases were included in the analysis. Failure to diagnose was the most common reason for litigation (n = 64, 63.4%), followed by negligent care resulting in an epidural haematoma (n = 44, 43.6%). Spine surgery (n = 29, 28.7%), trauma (n = 28, 27.7%), and epidural injection/catheter/electrode placement (n = 21, 20.8%) were the primary causes of haematomas. Neurosurgeons (n = 18, 17.8%) and anesthesiologists (n = 17, 16.8%) were the two most common physician specialties cited as defendants. Most cases resulted in a jury verdict in favour of the defense (n = 54, 53.5%). For cases ending in plaintiff verdicts, the average payout was $3 621 590.45, while the average payment for settlements was $2 432 272.73. Conclusion Failure to diagnose epidural haematomas is the most common reason for malpractice litigation, with neurosurgeons and anesthesiologists being the most common physician specialties to be named as defendants. More than half of all cases returned a jury verdict in favour of the defense and, on average, settlements proved to be more cost-effective than plaintiff verdicts.
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Affiliation(s)
- Isabella L. Pecorari
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, New York
- Department of Neurological Surgery Albert Einstein College of Medicine, Bronx, NY
| | - Vijay Agarwal
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, New York
- Department of Neurological Surgery Albert Einstein College of Medicine, Bronx, NY
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2
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Do Y, Lee E, Chee CG, Lee JW. [Lumbar Facet Joint Injection: A Review of Efficacy and Safety]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2024; 85:54-76. [PMID: 38362388 PMCID: PMC10864157 DOI: 10.3348/jksr.2023.0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 02/17/2024]
Abstract
Facet joint arthrosis is a progressive degenerative disease that is frequently associated with other spinal degenerative disorders such as degenerative disc disease or spinal stenosis. Lumbar facet joint arthrosis can induce pain in the proximal lower extremities. However, symptoms and imaging findings of "facet joint syndrome" are not specific as they mimic the pain from herniated discs or nerve root compression. Currently, evidence for therapeutic intra-articular lumbar facet joint injections is still considered low, with a weak recommendation strength. Nevertheless, some studies have reported therapeutic effectiveness of facet joint injections. Moreover, the use of therapeutic facet joint injections in clinical practice has increased. This review article includes opinions based on the authors' experience with facet joint injections. This review primarily aimed to investigate the efficacy of lumbar facet joint injections and consider their associated safety aspects.
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Bogdanovic S, Sutter R, Zubler V. Spine injections: the rationale for CT guidance. Skeletal Radiol 2023; 52:1853-1862. [PMID: 36149474 PMCID: PMC10449983 DOI: 10.1007/s00256-022-04188-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 02/02/2023]
Abstract
Back pain is one of the most common medical problems and is associated with high socioeconomic costs. Imaging-guided spinal injections are a minimally invasive method to evaluate where the back pain is originating from, and to treat patients with radicular pain or spinal stenosis with infiltration of corticosteroids. CT-guided spine injections are a safe procedure, characterized by precise needle placement, excellent visualization of the relevant anatomical structures, and low radiation exposure for the patient and the interventional radiologist. In this review article, the variety of applications of CT-guided injections (focused on nerve roots and epidural injections) and the optimal injection procedure as well as risks and side effects are discussed.
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Affiliation(s)
- Sanja Bogdanovic
- Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Reto Sutter
- Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Veronika Zubler
- Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
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Zhou Y, Guglielmi G, Garg S, Hankinson TC. Delayed Diagnosis of Cervical Epidural Hematoma in a 3-Year-Old Boy: A Case Report. JBJS Case Connect 2023; 13:01709767-202309000-00070. [PMID: 37651573 DOI: 10.2106/jbjs.cc.23.00170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
CASE A 3-year-old boy presented to the emergency department with torticollis after a fall. With normal cervical radiographs and neurologic exam, he was diagnosed with cervical strain and discharged. After 2-week progressive symptoms, he was referred to a pediatric spine surgeon. Magnetic resonance imaging (MRI) revealed a cervical epidural hematoma, which was then surgically evacuated. He recovered fully and remains symptom-free 2 years later. CONCLUSION Pediatric spinal epidural hematoma is a rare condition with potentially serious outcomes yet often nonspecific symptoms. Timely management based on a comprehensive evaluation of symptoms and imaging findings is crucial in improving patient outcomes.
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Affiliation(s)
- Yan Zhou
- University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado
| | - Gina Guglielmi
- Graduate Medical Education, Neurological Surgery Residency, Carle BroMenn Medical Center, Normal, Illinois
| | - Sumeet Garg
- Department of Orthopedics, Children's Hospital Colorado, Aurora, Colorado
- Department of Orthopedics, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado
| | - Todd C Hankinson
- Department of Neurosurgery, Children's Hospital Colorado, Aurora, Colorado
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado
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5
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Chen CL, Chang MH, Lee WJ. A Case Report: An Acute Spinal Epidural Hematoma after Acupuncture Mimicking Stroke. J Emerg Med 2020; 58:e185-e188. [PMID: 32204999 DOI: 10.1016/j.jemermed.2020.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/27/2019] [Accepted: 01/12/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Spinal epidural hematoma (SEH) after acupuncture is rare and may present with acute or subacute onset and varied symptoms, making it difficult to diagnose. This condition can mimic acute stroke, so it is vital to establish a clear diagnosis before considering thrombolytic therapy, which could be disastrous if applied inappropriately. CASE REPORT We describe a 52-year-old man who presented to our emergency department (ED) with acute onset of unilateral weakness of the limbs for 3.5 h immediately after receiving acupuncture at the bilateral neck and back. The acute stroke team was activated. In the ED, computer tomography angiography from the aortic arch to the head revealed spinal epidural hematoma. The patient was admitted to the ward for conservative treatment and was discharged with subtle residual symptoms of arm soreness 5 days later. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Acute spinal epidural hematoma rarely presents with unilateral weakness of the limbs, mimicking a stroke. Because inappropriate thrombolysis can lead to devastating symptoms, spinal epidural hematoma should be excluded when evaluating an acute stroke patient with a history of acupuncture who is a possible candidate for thrombolytic therapy.
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Affiliation(s)
- Chieh-Ling Chen
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ming-Hong Chang
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Wei-Ju Lee
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Dementia and Parkinson's Disease Integrated Center, Taichung Veterans General Hospital, Taichung, Taiwan; Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan
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6
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Aboumerhi H, Elmofty DH. Self-Limited Spinal Subarachnoid Hemorrhage After Lumbar Spinal Drain Removal While on Clopidogrel: A Case Report. A A Pract 2019; 13:436-439. [PMID: 31577536 DOI: 10.1213/xaa.0000000000001104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Spinal subarachnoid hemorrhage (SSH) is a rare yet potentially devastating complication of neuraxial procedures. We present a case of SSH after inadvertent lumbar spinal drain removal while on clopidogrel. The contrast between the patient's mild clinical symptoms compared to his impressive magnetic resonance imaging (MRI) highlights the variable presentations that can be seen with spinal and epidural hematomas. Despite sophisticated electronic warnings systems available to improve patient safety, better efforts are needed to improve interprofessional communication with providers taking care of patients with indwelling neuraxial catheters.
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Affiliation(s)
- Hassan Aboumerhi
- From the Department of Anesthesiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Dalia H Elmofty
- Department of Anesthesiology, University of Chicago, Chicago, Illinois
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7
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Babu JM, Patel SA, Palumbo MA, Daniels AH. Spinal Emergencies in Primary Care Practice. Am J Med 2019; 132:300-306. [PMID: 30291829 DOI: 10.1016/j.amjmed.2018.09.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 09/12/2018] [Accepted: 09/12/2018] [Indexed: 12/26/2022]
Abstract
Atraumatic spinal emergencies often present a diagnostic and management dilemma for health care practitioners. Spinal epidural abscess, cauda equina syndrome, and spinal epidural hematoma are conditions that can insidiously present to outpatient medical offices, urgent care centers, and emergency departments. Unless a high level of clinical suspicion is maintained, these clinical entities may be initially misdiagnosed and mismanaged. Permanent neurologic sequela and even death can result if delays in appropriate treatment occur. A focused, critical review of 34 peer-reviewed articles was performed to identify current data about accurate diagnosis of spinal emergencies. This review highlights the key features of these 3 pathological entities with an emphasis on appropriate diagnostic strategy to intervene efficiently and minimize morbidity.
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Affiliation(s)
- Jacob M Babu
- Division of Spine Surgery, Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI.
| | - Shyam A Patel
- Division of Spine Surgery, Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI
| | - Mark A Palumbo
- Division of Spine Surgery, Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI
| | - Alan H Daniels
- Division of Spine Surgery, Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI
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8
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Amoretti N, Baqué J, Litrico S, Stacoffe N, Palmer W. Serious Neurological Complication Resulting from Inadvertent Intradiscal Injection During Fluoroscopically Guided Interlaminar Epidural Steroid Injection. Cardiovasc Intervent Radiol 2019; 42:775-778. [PMID: 30603972 DOI: 10.1007/s00270-018-2151-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 12/18/2018] [Indexed: 11/25/2022]
Abstract
We describe the case of a 30-year-old patient who was referred for lumbar epidural corticosteroid injection due to right L5 radiculopathy. Two months earlier, MRI demonstrated a right large paracentral L4-L5 disk extrusion causing disabling L5 radiculopathy. The L4-L5 level was selected for interlaminar injection, using fluoroscopic guidance. During injection, the patient developed severe pain in both lower extremities. Thus, the procedure was immediately terminated. Paraplegia occurred within several minutes. Urgent lumbar spine CT and MRI demonstrated contrast material in a massive extruded disk fragment and substantial increase in size of the disk extrusion compared to pre-injection MRI. Emergency surgery was performed for lumbar decompression and discectomy. Although rare, serious neurological complication can result from inadvertent intradiscal injection of contrast material during lumbar epidural injection. This case illustrates the importance of recognizing the possibility of dynamic change in the size of an extruded disk fragment when the MRI precedes injection by a substantial time interval. LEVEL OF EVIDENCE: IV, Case Series.
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Affiliation(s)
- Nicolas Amoretti
- Hopital Pasteur 2, service de radiologie interventionnelle, Chu de Nice, 30, voie romaine, 06001, Nice, France.
| | - Jean Baqué
- Hopital Pasteur 2, service de radiologie interventionnelle, Chu de Nice, 30, voie romaine, 06001, Nice, France
| | - Stéphane Litrico
- Hopital Pasteur 2, service de radiologie interventionnelle, Chu de Nice, 30, voie romaine, 06001, Nice, France
| | - Nicolas Stacoffe
- Hopital Pasteur 2, service de radiologie interventionnelle, Chu de Nice, 30, voie romaine, 06001, Nice, France
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9
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Gungor S, Aiyer R. Epidural hematoma development contralateral to dura after lumbar transforaminal epidural steroid injection. Pain Manag 2017; 7:367-375. [DOI: 10.2217/pmt-2017-0012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Aim: To illustrate the anatomical and pathophysiological risks of epidural hematoma formation, other than direct needle trauma, after lumbar transforaminal epidural steroid injection in the setting of severe central canal stenosis. Case report: This case report presents the development of an epidural hematoma after lumbar transforaminal epidural steroid injection in a patient who has anatomical risk factor of severe lumbar spinal stenosis. The anatomic location of epidural hematoma was at the injected level, but on the contralateral side of the dura at a distance from the needle path. Epidural vascular anatomy and the potential mechanisms of bleeding in the epidural space in the absence of direct needle trauma, including the importance of injection pressures are discussed. Conclusion: This is the first reported case of an epidural hematoma on the contralateral side of the dura at a distance from the needle tip location, in the setting of severe central canal stenosis.
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Affiliation(s)
- Semih Gungor
- Division of Pain Medicine, Department of Anesthesiology, Hospital for Special Surgery, Weill Cornell Medical College, NY, USA
| | - Rohit Aiyer
- Department of Psychiatry, Hofstra Northwell Health, Staten Island University Hospital, NY, USA
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10
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Smith CC, Schneider B, McCormick ZL, Gill J, Loomba V, Engel AJ, Duszynski B, King W. Risks and Benefits of Ceasing or Continuing Anticoagulant Medication for Image-Guided Procedures for Spine Pain: A Systematic Review. PAIN MEDICINE 2017; 19:438-448. [DOI: 10.1093/pm/pnx152] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Clark C Smith
- Columbia University College of Physicians and Surgeons, New York, New York
| | | | | | - Jatinder Gill
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | - Wade King
- Manning Pain Management, Mayo Private Hospital, Taree, New South Wales, Australia
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11
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Abstract
Image-guided spinal injection is commonly performed in symptomatic patients to decrease pain severity, confirm the pain generator, and delay or avoid surgery. This article focuses on the radiologist as spine interventionist and addresses the following four topics relevant to the radiologist who performs corticosteroid injections for pain management: (a) the rationale behind corticosteroid injection, (b) the interaction with patients, (c) the role of imaging in procedural selection and planning, and (d) the pearls and pitfalls of fluoroscopically guided injections. Factors that contribute to the success of a pain management service include communication skills and risk mitigation. A critical factor is the correlation of clinical symptoms with magnetic resonance (MR) imaging findings. Radiologists can leverage their training in MR image interpretation to distinguish active pain generators in the spine from incidental abnormalities. Knowledge of fluoroscopic anatomy and patterns of contrast material flow guide the planning and execution of safe and effective needle placement. © RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- William E Palmer
- From the Department of Musculoskeletal Radiology, Massachusetts General Hospital, 55 Fruit St, YAW 6030, Boston, MA 02114
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12
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Domenicucci M, Marruzzo D, Pesce A, Raco A, Missori P. Acute Spinal Epidural Hematoma After Acupuncture: Personal Case and Literature Review. World Neurosurg 2017; 102:695.e11-695.e14. [PMID: 28377250 DOI: 10.1016/j.wneu.2017.03.125] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/23/2017] [Accepted: 03/25/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Spinal acupuncture is a relatively safe and common analgesic treatment, but it may be complicated by serious adverse effects, such as direct spinal cord and nerve root injury, subdural empyema, and epidural abscesses. In this report we compare our case of an extremely uncommon spinal epidural hematoma, which appeared after treatment by acupuncture, with other similar documented cases. CASE DESCRIPTION This is the case of a 64-year-old man who presented a left hemiparesis associated with paraesthesia. This appeared several hours after acupuncture treatment for left lumbosciatic pain. The cervicothoracic spine magnetic resonance imaging (MRI) scan showed a cervicothoracic spinal epidural hematoma from C2 to T12. The rapid improvement of the patient's neurologic symptoms justified the adoption of a conservative treatment strategy. This gave excellent long-term results. CONCLUSIONS Although a post-acupuncture spinal epidural hematoma (paSEH) is very rare, there are only 6 documented cases, it is a possible complication from acupuncture on the back. The use of very thin needles can produce bleeding, probably venous, in the epidural space. In general, this evolves more slowly than other kinds of epidural hematomas. The symptoms are also less severe, warranting less frequent surgical intervention, and in general there is a good outcome. The possibility of hematoma makes acupuncture contraindicated in patients who have coagulation disorders. The onset of severe spinal pain after spinal or paraspinal acupuncture treatment should lead to the suspicion of a paSEH, and a spinal MRI should be carried out.
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Affiliation(s)
- Maurizio Domenicucci
- Department of Neurology and Psychiatry, Neurosurgery, "Sapienza" University of Rome, Rome, Italy
| | - Daniele Marruzzo
- Department of Neurology "Lancisi,", Neurosurgery, A.O. "San Camillo", Rome, Italy
| | - Alessandro Pesce
- NESMOS Department, Neurosurgery, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy.
| | - Antonino Raco
- NESMOS Department, Neurosurgery, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Paolo Missori
- Department of Neurology and Psychiatry, Neurosurgery, "Sapienza" University of Rome, Rome, Italy
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13
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Velickovic M, Ballhause TM. Delayed onset of a spinal epidural hematoma after facet joint injection. SAGE Open Med Case Rep 2016; 4:2050313X16675258. [PMID: 27803810 PMCID: PMC5077070 DOI: 10.1177/2050313x16675258] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 09/12/2016] [Indexed: 11/20/2022] Open
Abstract
The treatment of chronic back pain is a challenging problem. Facet joint infiltration is an established treatment for chronic low back pain caused by arthrosis of the lumbar facet joints. Due to the increasing number of patients with chronic low back pain, this therapy has become more frequent. We treated a 51-year-old male patient, who developed an epidural hematoma 2 months after infiltration therapy. Our case shows that even a delayed onset of spinal epidural hematoma is possible and should be kept in mind as a possible cause of acute myelopathy after spinal intervention.
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Affiliation(s)
- Mirko Velickovic
- Department of Orthopedic Surgery, Sports Traumatology and Trauma Surgery, Wolfenbüttel Municipal Hospital, Wolfenbüttel, Germany
| | - Tobias M Ballhause
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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14
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Ji GY, Oh CH, Choi WS, Lee JB. Three cases of hemiplegia after cervical paraspinal muscle needling. Spine J 2015; 15:e9-13. [PMID: 25459742 DOI: 10.1016/j.spinee.2014.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 09/22/2014] [Accepted: 11/08/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Muscle needling therapy is common for chronic pain management, but the development of unusual complications such as hemiplegia is not well understood. PURPOSE We report on three cases with hemiplegia after cervical paraspinal muscle needling and propose possible explanations for these unusual complications. STUDY DESIGN Case report. METHODS The authors retrospectively reviewed the medical charts from a decade (2002-2013) at Korea University Hospital. The records were systematically searched, and the cases with hemiplegia (grade<3) after needing therapy were collected. No conflict of interest reported. No funding received. RESULTS A 54-year-old woman, a 38-year-old woman, and a 60-year-old man with hemiplegia by cervical subdural or epidural hematoma after cervical posterior paraspinal muscle needling without direct invasion (intramuscular stimulation, acupuncture, or intramuscular lidocaine) were observed. All patients were taken for emergent decompressive laminectomy, and their postoperative motor function improved substantially. CONCLUSION Spinal hematoma after muscle needling is unusual but was thought to result after a rupture of the epidural or subarachnoid veins by a sharp increase in blood pressure delivered in the intraabdominal or intrathoracic areas after needling therapy.
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Affiliation(s)
- Gyu Yeul Ji
- Depatment of Neurosurgery, Spine and Spinal Cord Research Institute, Yonsei University, College of Medicne, 50 Yonsei-ro, Seodamun-gu, 120-752 Seoul, Korea; Department of Neurosurgery, Guro Teun Teun Hospital, 547 Siheungdae-ro, Guro-gu, 152-880 Seoul, Korea
| | - Chang Hyun Oh
- Department of Neurosurgery, Guro Teun Teun Hospital, 547 Siheungdae-ro, Guro-gu, 152-880 Seoul, Korea
| | - Won-Seok Choi
- Department of Neurosurgery, Guro Teun Teun Hospital, 547 Siheungdae-ro, Guro-gu, 152-880 Seoul, Korea
| | - Jang-Bo Lee
- Department of Neurosurgery, Korea University Anam Hospital, College of Medicine, 73, Inchon-ro, Seongbuk-gu, 136-705 Seoul, Korea.
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15
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Lee MJ, Chung YS. Spinal subarachnoid hematoma as a complication of an intramuscular stimulation : case report and a review of literatures. J Korean Neurosurg Soc 2013; 54:58-60. [PMID: 24044084 PMCID: PMC3772290 DOI: 10.3340/jkns.2013.54.1.58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 05/06/2013] [Accepted: 07/08/2013] [Indexed: 12/28/2022] Open
Abstract
Intramuscular stimulation (IMS) is widely used to treat myofascial pain syndrome. IMS is a safe procedure but several complications have been described. To our knowledge, spinal subarachnoid hematoma has never been reported as a complication of an IMS. The authors have experienced a case of spinal subarachnoid hematoma occurring after an IMS, which was tentatively diagnosed as intracranial subarachnoid hemorrhage because of severe headache. Patient was successfully treated with surgery. Here, we report our case with a review of literature.
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Affiliation(s)
- Myeong Jong Lee
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Chungju, Korea
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16
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Yokoyama K, Kawanishi M, Yamada M, Tanaka H, Ito Y, Kuroiwa T. Spinal epidural hematoma following removal of incorrectly placed jugular central venous catheter. J Neurosurg Spine 2011; 15:206-9. [PMID: 21513426 DOI: 10.3171/2011.3.spine10900] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The authors report a rare case of iatrogenic spinal epidural hematoma associated with central venous catheter cannulation via the right internal jugular vein. This 59-year-old man was operated on for stomach cancer while under general anesthesia. A central venous line was inserted via the right internal jugular vein. The operation was completed uneventfully and postoperative fluid replacement was continued without interruption. On postoperative Day 2, marked swelling around the right side of his neck gradually worsened. Cervical CT demonstrated that the catheter tip of the central venous line had penetrated the jugular vein and entered the intervertebral foramen (C5-6), thereby reaching the spinal epidural space. The patient was immediately transported to the operating room and the catheter was carefully extracted under fluoroscopy. Several minutes after catheter removal, the patient complained of sudden severe back pain and over time developed mild paraparesis of both lower extremities. Urgent MR imaging of the spine revealed a large spinal epidural hematoma extending from C-1 to T-8 that was compressing the dorsal spinal cord. The patient underwent emergency surgical removal of the epidural hematoma as well as spinal cord decompression with a T1-4 laminectomy. After surgery, the patient showed full recovery of his lower-extremity motor function.
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Affiliation(s)
- Kunio Yokoyama
- Department of Neurosurgery, Takeda General Hospital, Fushimi, Kyoto, Japan.
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