Postdural puncture headache(PDPH)is an incapacitating complication that can occur following spinal anesthesia and with inadvertent dural puncture during epidural anesthesia.We present a case of a 32-year-old G2 P1 fem...Postdural puncture headache(PDPH)is an incapacitating complication that can occur following spinal anesthesia and with inadvertent dural puncture during epidural anesthesia.We present a case of a 32-year-old G2 P1 female who was admitted for induction of labor and received epidural catheter placement for analgesia.After an inadvertent dural puncture and development of a PDPH,the patient was offered conservative measures for the first 48 hours without improvement.An epidural blood patch(EBP)was placed achieving only moderate relief.Two days later,a second EBP was performed and the patient developed severe back pain which radiated bilaterally to her buttocks.Magnetic resonance imaging(MRI)demonstrated the presence of blood in the intrathecal space.This could be the cause of sacral radiculitis,an uncommon complication of an EBP.This suggests that EBPs could potentially cause neurologic symptoms which may be more common than people previously thought.As complicated outcomes have followed both conservative and aggressive management,MRI can be an early diagnostic tool in such cases and a multidisciplinary approach should be taken.展开更多
Anterior sacral meningocele is characterized by the herniation of the thecal sac into the retroperitoneal space. A 33-year-old man was referred to our hospital with the complaints of a longlasting constipation and non...Anterior sacral meningocele is characterized by the herniation of the thecal sac into the retroperitoneal space. A 33-year-old man was referred to our hospital with the complaints of a longlasting constipation and nonspecific lower abdominal pain. At ultrasound, a cystic mass was detected at the presacral space. Computed Tomography revealed a defect at the anterior aspect of the sacrum, together with a presacral cystic mass which showed a connection with the dural sac. At Magnetic Resonance Imaging, it was demonstrated that the cystic mass made an impression on the rectum, and did not possess any solid components. An anteroposterior pelvis radiogram demonstrated a sacral deformity and the scimitar sign. Upon these imaging findings, the patient got the diagnosis of an anterior sacral meningocele. The possibility of an anterior sacral meningocele must always be kept in mind in the differential diagnosis of a pelvic cystic mass.展开更多
This study analyzed the clinical characteristics and outcomes of sacral extradural spinal meningeal cysts with spinal nerve root fibers treated by reconstruction of the nerve root sheaths.The relationships between the...This study analyzed the clinical characteristics and outcomes of sacral extradural spinal meningeal cysts with spinal nerve root fibers treated by reconstruction of the nerve root sheaths.The relationships between the cysts and spinal nerve root fibers were examined microscopically,the cysts were partially excised,and the defects were oversewn to reconstruct the nerve root sheaths.The Improved Japanese Orthopedic Association(IJOA)scoring system was used to evaluate preoperative and postoperative neurological function.Thirty-eight patients were included in this study,with a mean age of 41.4±15.57 years.The mean IJOA score was 18.8±1.32 preoperatively and 19.6±0.65 postoperatively,which was a significant difference(t=–3.77,P=0.001).These results indicate a significant improvement in neurological function after surgery.The most significant improvement in neurological function was sensation(z=–2.86,P=0.004),followed by bowel/bladder function(z=–2.31,P=0.02).展开更多
A 64-year-old-female presented with progressive left foot weakness, low back and radicular pain after a left sided S1 transforaminal epidural steroid injection(ESI). Magnetic resonance imaging revealed left side L5-S1...A 64-year-old-female presented with progressive left foot weakness, low back and radicular pain after a left sided S1 transforaminal epidural steroid injection(ESI). Magnetic resonance imaging revealed left side L5-S1 large extradural heterogeneous mass with layering areas suggesting different stages of hematoma formation. Past medical history was significant for peripheral vascular disease and transient ischemic attacks, for which she took aspirin and clopidogrel(antiplatelet agent). These medications were discontinued one week prior to ESI. Although synovial cysts associated with facet arthropathy are common, hemorrhagic cyst is not. To the best of the authors' knowledge, this is the first reported case of symptomatic hemorrhagic lumbar facet synovial cyst following ESI on a patient taking antiplatelet medications.展开更多
BACKGROUND Symptomatic cervical facet cysts are relatively rare compared to those in the lumbar region.These cysts are usually located in the 7th cervical and 1st thoracic vertebral(C7/T1)area,and surgical excision is...BACKGROUND Symptomatic cervical facet cysts are relatively rare compared to those in the lumbar region.These cysts are usually located in the 7th cervical and 1st thoracic vertebral(C7/T1)area,and surgical excision is performed in most cases.However,facet cysts are associated with degenerative conditions,and elderly patients are often ineligible for surgical procedures.Cervical interlaminar epidural block has been used in patients with cervical radiating symptoms and achieved good results.Therefore,cervical interlaminar epidural block may be the first-choice treatment for symptomatic cervical facet cysts.CASE SUMMARY A 70-year-old man complained of a tingling sensation in the left hand,focused on the 4th and 5th fingers,for 1 year,and posterior neck pain for over 5 mo.The patient’s numeric rating scale(NRS)score was 5/10.The patient was diagnosed with symptomatic cervical facet cyst at the left C7/T1 facet joint.Fluoroscopyguided cervical interlaminar epidural block at the C7/T1 level with 20 mg triamcinolone and 5 mL of 0.5%lidocaine was administered.The patient's symptoms improved immediately after the block,with an NRS score of 3 points.After 3 mo,his left posterior neck pain and tingling along the left 8th cervical dermatome were relieved,with an NRS score of 2.CONCLUSION A cervical interlaminar epidural block is a good alternative for managing symptomatic cervical facet cysts.展开更多
基金supported in part by the University of California Davis Health Department of Anesthesiology and Pain MedicineNIH grant UL1 TR001860 of the University of California Davis Health。
文摘Postdural puncture headache(PDPH)is an incapacitating complication that can occur following spinal anesthesia and with inadvertent dural puncture during epidural anesthesia.We present a case of a 32-year-old G2 P1 female who was admitted for induction of labor and received epidural catheter placement for analgesia.After an inadvertent dural puncture and development of a PDPH,the patient was offered conservative measures for the first 48 hours without improvement.An epidural blood patch(EBP)was placed achieving only moderate relief.Two days later,a second EBP was performed and the patient developed severe back pain which radiated bilaterally to her buttocks.Magnetic resonance imaging(MRI)demonstrated the presence of blood in the intrathecal space.This could be the cause of sacral radiculitis,an uncommon complication of an EBP.This suggests that EBPs could potentially cause neurologic symptoms which may be more common than people previously thought.As complicated outcomes have followed both conservative and aggressive management,MRI can be an early diagnostic tool in such cases and a multidisciplinary approach should be taken.
文摘Anterior sacral meningocele is characterized by the herniation of the thecal sac into the retroperitoneal space. A 33-year-old man was referred to our hospital with the complaints of a longlasting constipation and nonspecific lower abdominal pain. At ultrasound, a cystic mass was detected at the presacral space. Computed Tomography revealed a defect at the anterior aspect of the sacrum, together with a presacral cystic mass which showed a connection with the dural sac. At Magnetic Resonance Imaging, it was demonstrated that the cystic mass made an impression on the rectum, and did not possess any solid components. An anteroposterior pelvis radiogram demonstrated a sacral deformity and the scimitar sign. Upon these imaging findings, the patient got the diagnosis of an anterior sacral meningocele. The possibility of an anterior sacral meningocele must always be kept in mind in the differential diagnosis of a pelvic cystic mass.
基金supported by grants from the Science Foundation for the Excellent Youth Scholars of Ministry of Education of China(200800011035)the National Natural Science Foundation of China(81200969/H0912)
文摘This study analyzed the clinical characteristics and outcomes of sacral extradural spinal meningeal cysts with spinal nerve root fibers treated by reconstruction of the nerve root sheaths.The relationships between the cysts and spinal nerve root fibers were examined microscopically,the cysts were partially excised,and the defects were oversewn to reconstruct the nerve root sheaths.The Improved Japanese Orthopedic Association(IJOA)scoring system was used to evaluate preoperative and postoperative neurological function.Thirty-eight patients were included in this study,with a mean age of 41.4±15.57 years.The mean IJOA score was 18.8±1.32 preoperatively and 19.6±0.65 postoperatively,which was a significant difference(t=–3.77,P=0.001).These results indicate a significant improvement in neurological function after surgery.The most significant improvement in neurological function was sensation(z=–2.86,P=0.004),followed by bowel/bladder function(z=–2.31,P=0.02).
文摘A 64-year-old-female presented with progressive left foot weakness, low back and radicular pain after a left sided S1 transforaminal epidural steroid injection(ESI). Magnetic resonance imaging revealed left side L5-S1 large extradural heterogeneous mass with layering areas suggesting different stages of hematoma formation. Past medical history was significant for peripheral vascular disease and transient ischemic attacks, for which she took aspirin and clopidogrel(antiplatelet agent). These medications were discontinued one week prior to ESI. Although synovial cysts associated with facet arthropathy are common, hemorrhagic cyst is not. To the best of the authors' knowledge, this is the first reported case of symptomatic hemorrhagic lumbar facet synovial cyst following ESI on a patient taking antiplatelet medications.
文摘BACKGROUND Symptomatic cervical facet cysts are relatively rare compared to those in the lumbar region.These cysts are usually located in the 7th cervical and 1st thoracic vertebral(C7/T1)area,and surgical excision is performed in most cases.However,facet cysts are associated with degenerative conditions,and elderly patients are often ineligible for surgical procedures.Cervical interlaminar epidural block has been used in patients with cervical radiating symptoms and achieved good results.Therefore,cervical interlaminar epidural block may be the first-choice treatment for symptomatic cervical facet cysts.CASE SUMMARY A 70-year-old man complained of a tingling sensation in the left hand,focused on the 4th and 5th fingers,for 1 year,and posterior neck pain for over 5 mo.The patient’s numeric rating scale(NRS)score was 5/10.The patient was diagnosed with symptomatic cervical facet cyst at the left C7/T1 facet joint.Fluoroscopyguided cervical interlaminar epidural block at the C7/T1 level with 20 mg triamcinolone and 5 mL of 0.5%lidocaine was administered.The patient's symptoms improved immediately after the block,with an NRS score of 3 points.After 3 mo,his left posterior neck pain and tingling along the left 8th cervical dermatome were relieved,with an NRS score of 2.CONCLUSION A cervical interlaminar epidural block is a good alternative for managing symptomatic cervical facet cysts.
