1 case of spinal cobwebitis caused by injection of spinal muscle pain point

Muscle fasciitis is a sterile inflammatory response to muscle and fascia, a common cause of neck pain, and is common inclinical, and its treatment synopsis includes medication, physiotherapy and invasive interventional therapyInvasive interventional therapy has the advantages of simple method, fast effect and precise effect, and is a treatment method commonly used in the outpatient clinic of painInvasive interventional treatment includes silver needle, small needle knife, pain point block and other treatment, in which pain block inclinicalis widely usedNeck pain block treatment can be serious adverse reactions such as spinal cord injury, cobwebitis, paraplegia and even death, at present, there is less literature on these serious complications of systematic treatment at home and abroadMy department for a case ofdiagnosisfor the neck muscle fasciitis patients after severe complications after treatment of pain point blocking, finallydiagnosisfor spinal spinal cobwebitis, after 2 weeks of intensive treatment improved, is summarized as follows1Case informationpatient, female, 31 years old, weight 53Kg The main complaint: "Neck pain 2 years, aggravated 3 days"; Check body: neck activity is no abnormal, side bendand left and right rotation of the neck when pain, C4, C6 level two-sided vertebrau muscle pressure ( Outpatient diagnosis is "neck fasciitis", after the patient's informed consent to the patient's pain point block treatment treatment: Choose 4 muscle pain points at the two-sided C4 and C6 level vertebrae The drug is 2% lidocain 5ml plus compound polysemeccsone (Debosong, J20080062, Mersadon, China) 1ml diluted to 20ml During operation, the patient rides on the treatment chair and tilts his head The puncture point is located in the middle of the spine open about 3 cm, puncture needle specification is 0.7mm x 30mm, puncture direction is the post-outward forward needle, needle depth of about 2.0 cm, back pumping no blood without fluid, to each point above analgesic 5 ml During treatment, the patient reported severe pain and did not have special treatment immediately after the end of treatment the patient complained of limb weakness, and then the sitting maintenance difficulties, immediately lifted the patient to the treatment bed, oxygen absorption, vital signs monitoring The patient's call should be, but the pronunciation and opening of the eyes difficult, the limbs of the soft powerless, all kinds of reflection disappeared, to treat the symptoms, the patient's symptoms significantly alleviated, the quadriplegic muscle strength recovery, accompanied by family members back home The patient was treated on the same day after 8h, reflecting weakness of limbs, physical discomfort and other symptoms, then emergency admission to the hospital for observation The patient's stay in hospital was 2 weeks, and the treatment plan during the hospitalization included glucocorticoid shock therapy, neurodehydratic treatment and nutritional neurotherapy, as well as specific treatment options (see Table 1) table 1 patient's specific treatment plan during hospitalization
patient in hospital 13d changed to oral meldonium nylon tablets, starting at 40 mg, halved every week, the last 5 mg after one week discontinuation In addition, the patient is admitted to hospital with related complementary treatment, such as the admission of 7d began to use medium-frequency electrical stimulation to promote nerve recovery, the use of metolazole, polyglutamamine particles to protect the stomach mucosa, the use of osteocol, calcium carbonate and potassium chloride to to prevent hormone-related complications Record changes in the patient's condition during hospitalization (see table 2) In addition, the patient in the hospital during cervical and thoracic MRI examination, the results show: C3-4, C4-5, C5-6 disc protruding, thoracic test results are not abnormal table 2 patients during the hospital condition changes
patients in the 3d under the defecation fruitless, sudden systemic limb spasms, the symptoms of a sexual aggravation, immediate lumbar puncture, puncture process has clear cerebrospinal fluid outflow, pressure is 180mm H2O, cerebrospinal fluid culture (-), suggesting that the above symptoms may lead to increased abdominal pressure The patient's blood routine results on the 1d, 5d and discharge days of admission indicated an increase in white blood cells of 9.77 x 109/L, 11.60 x 109/L and 16.99 x 109/L, respectively When the patient was discharged from the hospital muscle strength and feelingreturnd to normal, after January review, no abnormal performance, good outcome 2 Discussion of this case of patientdiagnosis as "neck fasciitis", immediately after injection of anti-inflammatory analgesic sacintics in the cervical spine appeared limb weakness, feeling disappeared and other symptoms, first consider inglion to the intra-hemp caused by the injection of the drug into the cobweb If it is purely a tint, after the metabolism of the drug, there may be low cranial pressure, headache symptoms, but after treatment 8h again the weakness of the limbs is very rare The therapeutic fluid contains granular hormone (Debaosong), which is shown in the literature to cause the risk of spinal cobwebitis This case patient admitted to the hospital 3d cerebrospinal fluid color bright, cerebrospinal fluid bacteria culture negative, and the patient's body temperature is not high, can be excluded from the infection and cobweb line bleeding caused by cobweb itis The final diagnosis is drug-based spinal cobwebitis spinal cobwebitis can be diagnosed through MRI and the patient's clinical performance Because MRI can identify normal spinal cord and injury sites, it is often used clinically as the main basis for imaging diagnosis of spinal cobwebitis Ludwig and others in the patient through the C6 intervertebral cavity of the epidural cavity injection, the patient in 15 min after treatment appeared in the left upper limb and double lower limb weakness, 24h MRI results show C4-5 plane high density signal shadow However, not all patients with spinal cobwebitis have MRI changes Bose performed C6-C7 epidural nerve resorresis on patients, who developed quadriplegia and respiratory inhibition, but NO significant imaging changes were found in MRI after 6h and 6 months after treatment No significant imaging changes were found in this patient, but their clinical manifestations suggested the presence of spinal cobwebitis In addition, spinal imaging can also be used as a diagnosis of spinal cord injury and spinal cobwebitis However, contrast agent has a stimulating effect on cobweb membrane, and the absorption under the cobweb membrane is slower, can induce and aggravate cobwebitis, and does not apply to the clinical diagnosis of this patient suspension agent coccocortisone subcranial cavity or intraspinal injection is the main cause of spinal cobweb itis, the incidence rate is 6% to 16%, the mechanism includes the direct injury of additive ingredients in the drug and the drug into the spinal cord cobweb blood vessel induced spinal cord injury, in which the drug enters the spinal cord web blood vessel , causing the spinal cord front artery embolism is the most common review of previous literature and found that the clinically commonly used meldonium nylon, Quanned, and pheasante can block the front altthotorial artery of the spinal cord, leading to ischemic injury in the spinal cord The way the drug enters the frontal artery of the spinal cord includes direct injection and through the spinal root artery into the front artery of the spinal cord Among them, the drug through the spinal root artery to the spinal front artery is more common When Brouwers etaled The C6 nerve root block, the drug was found to enter the spinal artery and the patient developed clinical manifestations of spinal prefrontal artery syndrome Verrills et al in the radiation through the intervertebral hole into the C5-6 epidural injection, the puncture needle bit tip placed in the intervertebral hole, then given the experimental dose of the contrast agent, and the contrast agent in real-time tracking found that the contrast agent through the spinal artery into the spinal front artery The main treatment options for spinal cobwebitis include the treatment of glucocorticoid shock, neurodehydration and nutritional nerves (1) glucocorticoid impact therapy: glucocorticoids have strong anti-inflammatory, antioxidant, reduce neuroedema, improve local blood circulation, and are often used in the treatment of spinal cord injury Methyl-sprinkle nylon can shorten the recovery time of nerve function and has fewside side effects, so it is commonly used clinically to shock the treatment of acute myelitis The recommended dose of methyl-spray nylon impact therapy is 7.5 to 30.0 mg-kg-1-d-1, and when the course of treatment is greater than 5d, the drug is gradually reduced to discontinued In this case, the dose of the 5d hormone increased from the previous day, is the third day after the disease after a sexual aggravation, adjusted drug dosage (2) Neurodewateration Treatment: Clinically commonly used neurodewatering agents include diuretic dewatering agents and high-permeable dewatering agents, including rheumatoids, which can lead to severe water electrolyte disorders, not preferred; (3) Nutritional Neurotherapy: The main drugs include: (1) drugs that promote the growth of nerve cells such as mono-salivaic acid tetrahexalysine neurosincosine, B vitamins, mouse nerve growth factors, etc.; Drugs such as olasitin; choline drugs such as cytophospholicholine; opioid receptor antagonists such as naloxone; (3) drugs that improve brain blood flow and microcirculation, such as lutein, and (4) antioxidants and cyclooxidase inhibitors such as Idarafon Therefore, the patient was treated with mono-salivary acid tetrahexalysine neurosinitine, methylcobalamin and mouse nerve growth factors avoiding drug injections in sub-cobwebs, spinal cords and blood vessels is the key to prevent drug-based cobwebitis CT can locate the position and depth of the puncture needle, avoid the puncture needle into the sub-cobweb cavity, before injection and give an ostomy agent can avoid the injection of the drug's blood vessels Furman and others found that the resuction test was 97.9% specific to the diagnosis of intravascular punctures, but its sensitivity was only 44.7%, so resuction did not completely exclude the injection of drugs into the blood vessels Because the blood flow faster, the contrast agent into the blood can be quickly taken away by the blood, and CT can only intermittently monitor the distribution of the contrast agent, so may appear the contrast agent's intravascular injection but not found , in contrast, digital endothema (DSA) can monitor the contrast agent in real time and find that intravascular injections are more likely than CT In addition, Doppler ultrasound can image blood vessels to avoid intravascular punctures and spinal cord injuries When the patient is discharged from the hospital, the patient basically recovers, but there are still some deficiencies in our treatment: (1) the initial dose of glucocorticoid impact therapy is less than the recommended dose of the drug; in short, this patient has serious complications due to a simple injection treatment, and fortunately, the recovery is good, this patient also gives us a profound lesson, the treatment process, although not perfect, I hope this case can bring inspiration and thinking to the same course