Effect of Microcirculation Reserves on Spinal Cord Recovery after Injury

Щурова, Е. Н.; Khudyaev, A. T.

doi:10.1023/b:hump.0000036336.13320.a5

Human Physiology

2004

DOI: 10.1023/b:hump.0000036336.13320.a5

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Effect of Microcirculation Reserves on Spinal Cord Recovery after Injury

Е. Н. Щурова

A. T. Khudyaev

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2010

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Cited by 1 publication

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“…Patients whose blood flow in the injury focus and adjacent regions increased by only 5-30% (8.6 ± 3.1%), after the decompression procedures did not show considerable improvement. The increase in their leg muscle strength was lower (59.4 ± 12.5%), there was no significant change in level of functional disturbance and the pain threshold changed nonsignificantly, and bowel/ bladder function was only slightly improved (15).…”

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confidence: 82%

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Peri-Venous Counter Spread — Be Prepared

Smith

Racz²,

Heavner³

2010

Pain Phys

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C ervical interventional chronic pain therapies generally involve injecting small volumes of fluid into the cervical epidural space via transforminal or interlaminar routes. Subsequent rapid fluid spread in the ventrolateral space may lead to local increases in epidural pressure. Fortunately, the fluid normally spreads laterally and the pressure returns to normal. The following actual case illustrates one potential pitfall of cervical interventional procedures. A 37-yearold right-handed white female complained of severe headaches and upper neck pain on the right side present for many years. She had been seen by numerous physicians and received many treatments all of which were ineffective. She was eventually diagnosed with occipital neuralgia. Occipital nerve blocks administered multiple times produced good results. A neurosurgeon transected the occipital nerve and the patient's pain improved initially, but in 4 to 6 months the pain returned. After about 4 more months, the frequency of her headaches increased from 4 times a month to about 6 times a month. Subsequently, the patient was diagnosed with cervical radiculopathy and a cervical epidural adhesiolysis was performed. The epidural catheter was threaded to the right side of the neck past the C-5-6 area where an epidurogram revealed a filling defect indicating epidural scaring was present. Stimulation of the right upper cervical nerve roots reproduced the patient's right-sided neck pain, supporting the clinical impression that these neural structures contributed to generation of the neck pain. The patient was sedated with a total of 50 mg of meperidine and 5 mg of diazepam and was responsive to verbal stimuli. Injection of local anesthetic did not produce motor block, indicating that there was no partial subdural or subarachnoid injection. Contrast was injected, followed by hyaluronidase, local anesthetics, and steroids. In the recovery area, the injection produced pain affecting the right side of the neck. The patient described the pain as radiating from the face to the ear, neck, right upper extremity, and subsequently all the way down to the right leg. The patient described pain affecting the right upper extremity-progressing to numbness and inability to move the right side. Additional sedation was given and the patient discharged home. Three days later a CT scan showed no evidence of spinal cord injury or hematoma formation. Neurological and neurosurgical consultation was sought. Right sided weakness persisted. Five days later an MRI study revealed cord edema from C2 to C7. Lower extremity function recovered essentially to normal in 4-5 months. Two years later, upper extremity function had improved significantly and, following appropriate physical therapy, had returned to the point where the patient was able to resume writing with the right hand. Ten years later, some residual weakness in pronation was still present. The most likely cause of the course of events following the cervical injection was compromise of spinal cord blood supply.

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confidence: 82%

“…The pain threshold decreased by 1.9 ± 0.2°. Bowel or bladder functions improved significantly or werecompletely restored (15).…”

mentioning

confidence: 97%

Peri-Venous Counter Spread — Be Prepared

Smith

Racz²,

Heavner³

2010

Pain Phys

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Effect of Microcirculation Reserves on Spinal Cord Recovery after Injury

Cited by 1 publication

References 13 publications

Peri-Venous Counter Spread — Be Prepared

Peri-Venous Counter Spread — Be Prepared

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