Tofuku Katsuhiro, Koga Hiroaki, Komiya Setsuro
Department of Orthopedic Surgery, Imakiire General Hospital, Kagoshima, Japan.
J Med Case Rep. 2012 Jun 1;6:142. doi: 10.1186/1752-1947-6-142.
Although uncommon, selective cervical nerve root blocks can have serious complications. The most serious complications that have been reported include cerebral infarction, spinal cord infarction, transient quadriplegia and death.
A 40-year-old Japanese woman with a history of severe right-sided cervical radicular pain was scheduled to undergo a right-sided C6 selective cervical nerve root block using a transforaminal approach under fluoroscopic guidance. An anterior oblique view of the C5-C6 intervertebral foramen was obtained, and a 23-gauge spinal needle, connected to the normal extension tube with a syringe filled with contrast medium, was introduced into the posterior-caudal aspect of the C5-C6 intervertebral foramen on the right side. In the anteroposterior view, the placement of the needle was considered satisfactory when it was placed no more medial than halfway across the width of the articular pillar. Although the spread of the contrast medium along the C6 nerve root was observed with right-sided C6 radiculography, the subdural flow of the contrast medium was not observed with real-time fluoroscopy. The extension tube used for the radiculography was removed from the spinal needle and a normal extension tube with a syringe filled with lidocaine connected in its place. We performed a negative aspiration test and then injected 1.5 mL of 1.0% lidocaine slowly around the C6 nerve root. Immediately after the injection of the local anesthetic, our patient developed acute flaccid paralysis, complained of breathing difficulties and became unresponsive; her respiratory pattern was uncoordinated. After 20 minutes, she regained consciousness and became alert, and her muscle strength in all four limbs returned to normal without any sensory deficits after receiving emergent cardiorespiratory support.
We believe that confirming maintenance of the appropriate needle position in the anteroposterior view by injecting local anesthetic is important for preventing central needle movement. Because the potential risk of serious complications cannot be completely eliminated during the use of any established selective cervical nerve root block procedure, preparation for an emergency airway, ventilation and cardiovascular support is indispensable in cases of high spinal cord anesthesia.
尽管选择性颈神经根阻滞并不常见，但可能会出现严重并发症。已报道的最严重并发症包括脑梗死、脊髓梗死、短暂性四肢瘫痪和死亡。
一名40岁的日本女性，有严重的右侧颈神经根性疼痛病史，计划在透视引导下采用经椎间孔入路进行右侧C6选择性颈神经根阻滞。获得了C5-C6椎间孔的前斜位视图，将一根23号脊髓穿刺针连接到装有造影剂的注射器的普通延长管上，插入右侧C5-C6椎间孔的后尾侧。在前后位视图中，当穿刺针放置在关节突宽度的一半以内且不更偏向内侧时，认为穿刺针位置满意。尽管在右侧C6神经根造影时观察到造影剂沿C6神经根扩散，但在实时透视下未观察到造影剂的硬膜下流动。用于神经根造影的延长管从脊髓穿刺针上取下，取而代之的是连接有装有利多卡因注射器的普通延长管。我们进行了负压抽吸试验，然后在C6神经根周围缓慢注射1.5 mL 1.0%的利多卡因。注射局部麻醉剂后，患者立即出现急性弛缓性麻痹，诉说呼吸困难，失去反应；她的呼吸模式不协调。20分钟后，她恢复意识并变得警觉，在接受紧急心肺支持后，她四肢的肌肉力量恢复正常，没有任何感觉障碍。
我们认为通过注射局部麻醉剂在前后位视图中确认穿刺针位置合适对于防止穿刺针向中心移动很重要。因为在使用任何既定的选择性颈神经根阻滞程序时，严重并发症的潜在风险都无法完全消除，所以在高位脊髓麻醉的情况下，准备紧急气道、通气和心血管支持是必不可少的。
