Application of ultrasound-guided C5 nerve root block using polydeoxyribonucleotide in traumatic C5 nerve root injury caused by fracture of the articular process of the cervical spine

Abstract

Rationale:Cervical nerve root injury is one of the complications of traumatic cervical spine fracture. Although one of the most effective treatments to reduce inflammation in nerve root injuries is the use of corticosteroids or nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids and NSAIDs can inhibit bone healing. So, when nerve injury accompanies bone fractures, corticosteroids and NSAIDs have limitations as therapeutic agents. However, polydeoxyribonucleotide (PDRN) may be useful in the treatment of neuropathy or musculoskeletal pain patients with contraindication of the use of corticosteroids because of its anti-inflammatory effect, as revealed in previous studies. To the best of our knowledge, there has been no report of treatment of traumatic nerve root injury due to an articular process fracture with an ultrasound-guided cervical nerve root block (NRB) using PDRN.Patients concerns:A 54-year-old female patient with motor weakness of the left upper extremity and tingling sensation in the left neck and shoulder.Diagnoses:traumatic C5 nerve root injury due to a fracture of the left articular process in the C4 spine.Intervention:Ultrasound-guided C5 NRB using PDRN.Outcomes:Her motor weakness and sensory symptoms of the left upper extremity were significantly improved after treatment using an ultrasound-guided C5 NRB using PDRN.Lessons:Although it is impossible to draw a conclusion from a single case report, we suggest the ultrasound-guided NRB using PDRN could be a useful treatment for alleviating motor weakness and neuropathic pain caused by traumatic spinal nerve root injury in situations where corticosteroids cannot be used.

Clinical characteristics of patients with posterosuperior labral tear: a comparison with patients with other shoulder disorders

“… 15 , 16 A Spurling test was also performed to rule out the presence of cervical radiculopathy. 17 , 18 …”

Polydeoxyribonucleotide Regulation of Inflammation

“…92 Ultrasoundguided PDRN in a patient with cervical nerve root injury, a complication of traumatic cervical spine fracture, improved motor weakness and sensory symptoms after the second injection. 93 The safety profile of PDRN has prompted its use in patients with metabolic syndromes, such as diabetes, a clinical condition for which corticosteroids have glucose-related adverse effects. 94 Reports on the success of PDRN injections for the management of carpal tunnel syndrome 95 and lumbosacral radiculopathy 96 in patients with diabetes mellitus have been recently published.…”

Distribution Patterns of Vasculature Around Cervical Nerve Roots

“…Before the CNRB was performed, we evaluated the vulnerable blood vessels around each C3-C7 nerve root of the patient's painful side, with color Doppler imaging in an ultrasound examination. Ultrasound evaluations were performed using a standard ultrasound device (Samsung Medison, Hongchun, Korea) and a highfrequency linear transducer (5)(6)(7)(8)(9)(10)(11)(12). With patients placed in a supine position, their heads were rotated 30 to 40 away from the painful side.…”

“…4 To avoid the penetration of critical vessels, the needle approach in the posterior aspect of the foramen has been popularly used in fluoroscopy-guided CNRB. 1,2,5,6 However, there is always an underlying risk of severe complications due to unintentional intra-arterial injection despite following strict guidelines to minimize the risk. 7 Recently, the use of ultrasound-guided CNRB has been gradually increasing.…”

“…7 Recently, the use of ultrasound-guided CNRB has been gradually increasing. 1,5 However, because this technique cannot make perforating vessels visible and may not be able to differentiate arterial from venous flow, it is currently recommended that ultrasound never be used in isolation, and the findings must be confirmed with fluoroscopy. Also, there has not been a study of the vulnerable vessels at C3-7 during CNRB that can be visualized with ultrasound.…”