Park Donghwi, Seong Min Yong, Kim Ha Yong, Ryu Ju Seok
From the Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu, Korea (DP); Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea (MYS, HYK); and Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, South Korea (JSR).
Am J Phys Med Rehabil. 2017 Jun;96(6):e111-e114. doi: 10.1097/PHM.0000000000000613.
Ultrasound-guided cervical medial branch block (CMBB) is commonly performed to diagnose and treat head, neck, and shoulder pain. However, its use at the C7 level has been shown to be less accurate than at other levels, which may increase the chance of injury owing to the imprecision of needle site provided by the ultrasound guide. We report the first case of iatrogenic spinal cord injury from an ultrasound-guided C7 CMBB. The patient, upon receiving this procedure, had fainted shortly after experiencing an electrical sensation that ran from the neck to the toe. The patient complained of weakness and tingling sensation in the left upper extremity. Cervical magnetic resonance imaging revealed a hematoma in the cervical spinal cord, and an electrophysiological study, which was performed at 3 weeks after the incident, revealed an injury at the left C3-T2 anterior horn. After 2 months of rehabilitation, the patient showed moderate improvement in the strength of the left proximal upper extremity; however, there was no improvement in the strength of the left distal upper extremity. Therefore, we recommend caution when performing ultrasound-guided CMBB at the C7 level, as the guide particularly at this level is relatively inaccurate, posing a risk of spinal cord injury.
超声引导下的颈椎内侧支阻滞（CMBB）常用于诊断和治疗头、颈及肩部疼痛。然而，已证实其在C7水平的应用准确性低于其他水平，这可能因超声引导所提供的穿刺部位不准确而增加损伤几率。我们报告首例因超声引导下C7水平CMBB导致的医源性脊髓损伤病例。该患者在接受此操作后，在经历了从颈部至脚趾的电击感后不久便晕倒。患者主诉左上肢无力及刺痛感。颈椎磁共振成像显示颈髓有血肿，事件发生3周后进行的电生理研究显示左侧C3 - T2前角损伤。经过2个月的康复治疗，患者左上肢近端肌力有中度改善；然而，左上肢远端肌力并无改善。因此，我们建议在C7水平进行超声引导下CMBB时要谨慎，因为在此水平引导相对不准确，存在脊髓损伤风险。
