• Journal of Korean Neurosurgical Society
• /
• v.58 no.5
• /
• pp.483-486
• /
• 2015

Cervical epidural steroid injection is frequently used in the conservative management of neck pain and cervical radiculopathy. Epidural cervical transforaminal injections are usually well-tolerated with mild side effects such as transient decreased sensory and motor function, or headache due to dural puncture. Although there are a few case reports about adverse effects of cervical epidural injection in the literature, it can cause severe complications such as large hematoma, infarction by spinal vascular injury. Subdural hematoma has been occurred much less common rather than epidural hematoma in the spinal cord. We report a rare catastrophic case of cervical spinal subdural hematoma with quadriparesis after cervical transforaminal epidural block.

• The Korean Journal of Pain
• /
• v.22 no.2
• /
• pp.158-162
• /
• 2009

Background: The loss of resistance (LOR) method is most commonly used to identify the epidural space. This method is thought to rely on the penetration of the ligamentum flavum. Unfortunately the exact morphology of the ligamentum flavum is variable at different vertebral levels. Especially, it has been pointed out that the lower cervical ligamentum flavum may be discontinuous in the midline in up to 50% of patients. Thus, the LOR method may be inaccurate to confirm the cervical epidural space. The aim of this study is to determine which method is the safest and most exact for confirming the cervical epidural space. Methods: 100 adult, chronic renal failure patients who were undergoing an arteriovenous bridge graft for hemodialysis at the upper arm under cervical epidural anesthesia were recruited for this study. During the cervical epidural puncture, we identified the cervical epidural space by subjectively feeling the resistance with using a finger just through the ligamentum flavum, and we also used the drip infusion method, the loss of resistance method using air, and the hanging drop method. By using 5 grades, we classified the extent of whether or not the techniques were effective. Results: Using the drip infusion method, we identify the epidural space in all the patients as ＋/＋＋ grade. The catheter insertion method was also successful in identifying those epidural spaces over a ${\pm}$ grade. The pseudo LOR was over ${\pm}$ grade in 47 patients. Conclusions: The combined LOR/hanging drop with drip infusion method is useful for confirming the cervical epidural space.

• The Korean Journal of Pain
• /
• v.11 no.1
• /
• pp.143-145
• /
• 1998

There are reports on cervical epidural anesthesia for surgery of neck, chest and upper limb. However, there are limited published data on the specific problems with this procedure, including dural puncture, epidural abscess, and vasovagal syncopes. We experienced two cases of vasovagal syncope during cervical epidural anesthesia in the sitting position. These syncopes consisted of sudden hypotention and bradycardia, associated with nausea, dizzness and sweating. The patients were resuscitated successfully and recovered without any adverse effects. Current literature is being reviewed and the possible mechanisms of cardiac arrest under cervical epidural anesthesia in the sitting position are being discussed.

• The Korean Journal of Pain
• /
• v.24 no.3
• /
• pp.169-171
• /
• 2011

Postherpetic neuralgia is the most frequent complication of herpes zoster. Treatment of this neuropathic pain syndrome is difficult and often disappointing. Although postherpetic neuralgia is generally a self-limited condition, it can last indefinitely. Continuous epidural blockade for patients with acute zoster can shorten the duration of treatment. However, continuous epidural block has some complications such as infection, dural puncture, and total spinal and nerve damages. We report a case of myoclonus during continuous epidural block with ropivacaine, morphine, and ketamine in an acute zoster patient.

• The Korean Journal of Pain
• /
• v.12 no.1
• /
• pp.157-161
• /
• 1999

We report a patient with spontaneous intracranial hypotension. In addition to the cardinal feature of a postural headache and a low CSF pressure, the patient also had subdural hematoma demonstrated by brain MRI. Radionuclide cisternography revealed a CSF leakage in the intracranium. CSF leakage from spinal meningeal defects may be the most common cause of this syndrome. The headache is a consequence of the low CSF pressure producing displacement of pain-sensitive structures. Methods of treatment are identical to those for post-dural puncture headaches. We experienced a patient with spontaneous intracranial hypotension developed in the intracranium who was successfully managed with a cervical blood patch.

• The Korean Journal of Pain
• /
• v.23 no.1
• /
• pp.46-50
• /
• 2010

Spontaneous intracranial hypotension (SIH) is considered to be a very rare disorder. It is characterized by an orthostatic headache that is aggravated with the patient in the upright position and it is relieved by the patient assuming the supine position. SIH is caused by a spontaneous spinal cerebrospinal fluid leakage without the patient having undergone trauma, surgery or dural puncture or having any other significant medical history. An autologous epidural blood patch (EBP) is effective in relieving SIH. We report here on a case of SIH with cerebrospinal fluid leakage at the upper cervical vertebral level and the middle thoracic vertebral level. The points of leakage were identified by radionuclide cisternography, and this patient was successfully managed by injecting an EBP at each level of leakage.

• The Korean Journal of Pain
• /
• v.1 no.1
• /
• pp.20-27
• /
• 1988

Continuous cervical epidural anesthesia with two different concentrations of bupivacaine had been performed in 43 cases for surgery of upper extremity and cervical spine. After the initial dose of 0.33% bupivacaine 15ml to Group I(n=22) and 0.5% bupivacaine 15ml to Group II(n=21) was injected respectively, we observed the circulatory and pulmonary functions to be changed, and evaluated the duration of those analgesic action. The number of spinal segment to be affected and the complications were checked. Statistical significance of changes after the initial dose in both groups was determined by student's t-test. All values are impresed as mean$\pm$1S.D.. The results were as follows: 1) Circulatory functions; Systolic B.P. and Pulse rate were decreased by 10~15torr and 5~6 beats per minute respectively between 10~30 minutes following the initial dose, which were statistically significant in both groups. 2) Pulmonary functions; The diminution of minute volume showed to 20% and a rise of $PaCO_2$ level to 5~6 torr respectively between 30~60 minutes following the initial dose, which were statistically significant in both groups. There were no significant changes in self respiration and respiratory rate in both groups. 3) The duration of analgesic action was $72.3{\pm}25.7$(min) in Group I and $83.5{\pm}28.5$(min) in Group II which was not statistically significant between two groups, and the number of affected spinal segment at ore hour following the Anesthusia was $8.7{\pm}2.0$ in Group I and $10.5{\pm}2.4$ in Group II which was statistically significant between two groups. 4) Complications; a. Hypotension(below 80torr in systolic pressure) was appeared in 5% of all patients. b. Bradycardia(below 60 beats per minutes) was appeared in 25% of all patients. c. Inadvertent dural puncture was developed in only one patient, In conclusion, the 0.33% bupivacaine as well as 0.5% bupivacaine were enough for those analgesic effect in the above mentioned surgery even though the duration of analgesic action was about 10 minutes shorter in Group I than that of Group II. The cardiopulmonary function was clinically rather stable in Group I than that of Group II. Therefore we thought 0.33% bupivacaine was satisfactory for the clinical practicality in the cervical epidural anesthesia.

• Journal of Korean Neurosurgical Society
• /
• v.29 no.2
• /
• pp.240-248
• /
• 2000

Objective : Spontaneous intracranial hypotension is a rarely reported syndrome of spontaneous postural headache associated with low CSF pressure and has rarely been demonstrated radiographically or surgically. But recently, it is being recognized with increasing frequency. The purpose of this study was to characterize clinical and imaging features, etiologic factors, and outcome in the spontaneous intracranial hypotension. Patients and Methods : We reviewed our experience with documented cases of spontaneous intracranial hypotension in 5 consecutive patients with orthostatic headaches from April 1998 to April 1999. Results : The mean age was 41 years(from 35 to 49 years). All patients had postural headaches, which were completely alleviated by recumbency position. Nausea, neck pain, horizontal diplopia, photophobia, and blurred vision were noted in some of the patients. Brain MRI showed diffuse pachymeningeal gadolinium enhancement, subdural collections of fluid, and descent of the brain. The opening pressure from lumbar puncture was $4cmH_2O$ or less in three of five patients whereas the opening pressure was within normal range in two patients. All patients underwent radioisotope cisternography and computerized tomographic myelography. On radioisotope cisternography, CSF leakage was suspected at the level of cervical area(1 patient), upper thoracic area(2 patients), mid-thoracic area(1 patient). Computed tomography myelography revealed extraarachnoid accumulation of contrast media(compatible finding with CSF leakage) at the level of cervical or thoracic area. In all patients, the symptoms resolved in response to supportive measures or epidural blood patch(1 patient). Conclusion : Spontaneous spinal CSF leakage is increasingly recognized as a cause of spinal postural headache. Most CSF leaks are located at the cervicothoracic junction or in the thoracic spine and can be demonstrated by variable diagnostic method. The condition is usually self-limiting and its prognosis is typically good.