Myelopathy after the Intrathecal Administration of Hypertonic Saline

Kim, R C; Porter, R.; Choi, Byung Ho; Kim, S W

doi:10.1227/00006123-198805000-00026

Cited by 38 publications

(16 citation statements)

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“…first used intrathecal hypertonic saline in cancer patients (7,13) to treat pain , when hypertonic saline is injected intrathecally, like with other neurolytic agents, severe pain and muscle cramps, hypertension, cardiac arrhythmia, pulmonary edema, cerebral infarction do occur. Localized paresis lasting hours, paresthesia lasting for weeks, transient hemiplegia, and persisting loss of sphincter control with sacral anesthesia have been reported (2,14,15).…”

Section: Discussionmentioning

confidence: 99%

Complications of Epidural Neuroplasty: A Retrospective Evaluation

Talu

Erdine

2003

Neuromodulation: Technology at the Neural Interface

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Percutaneous epidural neuroplasty (lysis of epidural adhesions, epidural application of hypertonic saline) is an interventional technique for the management of pain due to spinal disorders. Epidural neuroplasty is found to be effective in removing fibrous tissue occurring in the epidural space for various reasons, however, the procedure may be prone to serious complications. We present here our retrospectively collected complications and precautions of complications of epidural neuroplasty in 250 patients. Neuroplasty, as per the technique of Racz et al., was only considered in patients suffering from low back and cervical pain after conservative treatments had been tried and had failed. Possible known complications include bending of the tip of the introducer needle, shearing/tearing of the catheter, misplacement of the catheter, inadvertent blockage of the catheter or catheter tip, migration of the catheter, hypotension, respiratory depression, urinary and/or fecal incontinence, urinary hesitancy, sexual dysfunction, paresthesia, epidural abscess, and meningitis. We found the following complications in our series: the tips of the introducer needle were bent in 12 patients; catheter sheaths were torn during withdrawal through the needle in three patients; 39 patients had bleeding or aspiration of blood from the epidural space; eight patients had their catheters migrate into an epidural vein; one patient's catheter migrated into the prevertebral space during the procedure; there were dural punctures in 11 patients; there were catheter blockages in six patients during consecutive applications of neuroplasty; hypotension was seen during and after drug injections in 12 patients, there was hypotension in one patient; three patients had migration and penetration of their catheters into the dura after placement and in consecutive days; 25 patients experienced numbness in dermatomal areas of the upper and lower extremities depending the level of the procedure; and there were eight infections at the entry site of the catheter, three epidural abscesses, and two patients with meningitis. In order to prevent complications such as those seen, epidural neuroplasty procedures must be performed in well-equipped centers by experienced hands.

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Section: Discussionmentioning

confidence: 99%

Complications of Epidural Neuroplasty: A Retrospective Evaluation

Talu

Erdine

2003

Neuromodulation: Technology at the Neural Interface

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“…The contents of the sac need to be preserved as the sac invariably contains vital structures. Transsphenoidal encephalocele has been treated by either the transcranial[1516] or the transpalatal approach. [916]…”

Section: Discussionmentioning

confidence: 99%

Transalar transphenoidal meningoencephalocele: A rare cause of respiratory distress in a neonate

et al. 2011

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“…There is also need to re‐evaluate, in cases of non‐cancer pain, the administration of neurolytic substances into the epidural space; contrary to earlier belief, they have been shown to cross the meningeal barrier (41, 89–92) or, as in some other instances, they may accidentally be injected intradurally (51); either way, the meningeal barrier is vulnerable to puncture or osmosis and neither of these phenomena can be controlled or guaranteed not to occur.…”

Section: Other Factorsmentioning

confidence: 99%

Neurologic deficits and arachnoiditis following neuroaxial anesthesia

Aldrete¹

2002

Acta Anaesthesiol Scand

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Of late, regional anesthesia has enjoyed unprecedented popularity; this increase in cases has brought a higher frequency of instances of neurological deficit and arachnoiditis that may appear as transient nerve root irritation, cauda equina, and conus medullaris syndromes, and later as radiculitis, clumped nerve roots, fibrosis, scarring dural sac deformities, pachymeningitis, pseudomeningocele, and syringomyelia, etc., all associated with arachnoiditis. Arachnoiditis may be caused by infections, myelograms (mostly from oil-based dyes), blood in the intrathecal space, neuroirritant, neurotoxic and/or neurolytic substances, surgical interventions in the spine, intrathecal corticosteroids, and trauma. Regarding regional anesthesia in the neuroaxis, arachnoiditis has resulted from epidural abscesses, traumatic punctures (blood), local anesthetics, detergents, antiseptics or other substances unintentionally injected into the spinal canal. Direct trauma to nerve roots or the spinal cord may be manifested as paraesthesia that has not been considered an injurious event; however, it usually implies dural penetration, as there are no nerve roots in the epidural space posteriorly. Sudden severe headache while or shortly after an epidural block using the loss of resistance to air approach usually suggests pneumocephalus from an intradural injection of air. Burning severe pain in the lower back and lower extremities, dysesthesia and numbness not following the usual dermatome distribution, along with bladder, bowel and/or sexual dysfunction, are the most common symptoms of direct trauma to the spinal cord. Such patients should be subjected to a neurological examination followed by an MRI of the effected area. Further spinal procedures are best avoided and the prompt administration of IV corticosteroids and NSAIDs need to be considered in the hope of preventing the inflammatory response from evolving into the proliferative phase of arachnoiditis.

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Myelopathy after the Intrathecal Administration of Hypertonic Saline

Cited by 38 publications

References 0 publications

Complications of Epidural Neuroplasty: A Retrospective Evaluation

Complications of Epidural Neuroplasty: A Retrospective Evaluation

Transalar transphenoidal meningoencephalocele: A rare cause of respiratory distress in a neonate

Neurologic deficits and arachnoiditis following neuroaxial anesthesia

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