Segmental Spinal Myoclonus Complicating Lumbar Transforaminal Epidural Steroid Injection

Wong, Stanley Sau Ching; Qiu, Qiu; Cheung, Chi Wai

doi:10.1097/aap.0000000000000742

Cited by 6 publications

(4 citation statements)

References 13 publications

(15 reference statements)

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“…Although a LEI is generally considered a safe procedure, it is associated with several complications, such as hematomas, allergic reactions, and infections. 8,9 Infections after lumbar surgery have a considerable impact on recovery. The infection rate after posterior lumbar instrumented surgical procedures is approximately 3%.…”

Section: Introductionmentioning

confidence: 99%

<p>Infection Risk of Lumbar Epidural Injection in the Operating Theatre Prior to Lumbar Fusion Surgery</p>

Li¹,

Hou²,

Gao³

et al. 2020

JPR

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Purpose: To determine the association between preoperative lumbar epidural injections (LEIs) in the operating theater (OR) and the occurrence of surgical site infection (SSI) after posterior lumbar instrumented fusion surgery. Methods: This study was performed from January 2015 to September 2019. We enrolled 2312 patients who underwent lumbar surgery without LEIs (control group) and 469 patients who underwent lumbar surgery after LEIs in the OR. We further separated the patients by the time interval between the LEIs and surgery: 1) for the 0-1 M group, lumbar surgery was performed within 1 month after the LEIs, and 2) for the >1 M group, it was performed more than 1 month after the LEIs. Results: The postoperative infection rate in the 0-1 M group was considerably higher than that in the control group (p = 0.0101). We further subdivided the 0-1 M and >1 M groups into four subgroups: a) the 0-1 MNS group included patients in the 0-1 M group who did not receive steroids; b) the 0-1 MS group who received steroids; c) the >1 MNS group included patients in the >1 M group who did not receive steroids; d) the >1 MS group who received steroids. The postoperative infection rate in the 0-1 MS subgroup was considerably higher than that in the control group (p = 0.0018). However, the infection rate was lower in the >1 MS subgroup (p = 0.1650). There were no statistically significant differences in the postoperative infection rate between the control group and the two non-steroid groups (0-1 MNS group, p = 0.4961; 1 MNS group, p = 0.7381). Conclusion: The administration of LEIs without steroids in the OR before lumbar instrumented fusion does not significantly increase patients' risk of postoperative infection. We recommend avoiding steroid injections administered within 1 month before lumbar instrumented fusion.

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Section: Introductionmentioning

confidence: 99%

<p>Infection Risk of Lumbar Epidural Injection in the Operating Theatre Prior to Lumbar Fusion Surgery</p>

Li¹,

Hou²,

Gao³

et al. 2020

JPR

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“…[16,17] Although many studies have reported that there are several adverse reactions to the treatment of lumbar disc herniation by epidural injection of glucocorticoids, common complications include nausea, headache, dizziness, facial flushing, and vasovagal attack. [18] Some rare major complications reported include paralysis, cerebrospinal fluid leakage, spinal cord infarction, cerebral ischemia, spinal cord myoclonus, and epidural hematoma inhibition of the hypothalamic-pituitaryadrenocortical axis, [2,[18][19][20][21] and most of the adverse reactions can be attributed either to direct damage of blood vessels or the injection of drugs into the blood vessels. It is suggested that the exact location of the puncture needle, the use of nongranular glucocorticoids, such as betamethasone, real-time fluoroscopy, digital subtraction angiography, and the operator's familiarity with the contrast pattern of fluoroscopy should be used as much as possible to reduce the occurrence of these risks.…”

Section: Discussionmentioning

confidence: 99%

A comparison between transforaminal lumbar epidural injection performed under picture archiving and communication systems-based magnetic resonance imaging planning and injection under immediate X-ray guidance

Yan,

Romeo Kenmegne,

et al. 2023

Jt Dis Relat Surg

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Objectives The study aimed to compare the treatment cost, operation time, clinical effect, and complications between punctures done under magnetic resonance imaging (MRI) planning based on picture archiving and communication systems (PACS) and punctures done under immediate X-ray fluoroscopy guidance in the treatment of lumbar disc herniation by transforaminal lumbar epidural injection. Patients and methods In this prospective study conducted between October 2016 and June 2021, 128 patients were randomly divided into Groups A and B by the random number table method. In Group A (n=66; 36 males, 30 females; mean age: 64.5±2.4 years, range, 50 to 72 years), puncture was performed by planning with PACS-based MRI; in Group B (n=62; 34 males, 28 females; mean age: 65.3±2.6 years; range, 48 to 73 years), puncture was performed under immediate X-ray guidance. The cost of treatment, duration of procedure, clinical outcome, and complications were compared between the two groups. Results The difference in treatment cost in Groups A and B was statistically significant (p<0.001), with 755.67±29.45 yuan and 1.158.08±43.92 yuan, respectively. The mean treatment time was statistically significant (p<0.001) between the groups, with 21.16±1.91 min in Group A and 37.26±2 min in Group B. However, there was no significant difference between Group A and Group B in terms of improvement in pain scores and Oswestry disability index (both p>0.05). There was also no significant difference between Group A and Group B in terms of complication rates (both p>0.05). Conclusion Compared to immediate X-ray guided puncture, the puncture method using PACS for MRI planning shortened the transforaminal lumbar epidural injection procedure time and reduced the treatment costs without exposing the physician or patient to additional radiation, while there was no significant difference in the short-term clinical outcome or complication rate.

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“…The physiologic characteristics of segmental myoclonus include burst duration ranges between 50 and 500 milliseconds without caudo-rostral propagation. 26,27 The physiologic characteristics of propriospinal myoclonus include long burst durations typically ranging from~150 to 450 milliseconds (can be even longer). Conduction velocity of the efferent volley ranges from 5 to 15 m/sec limited to the spinal cord without any cranial nerve innervated muscle activation.…”

Section: Brainstem Myoclonusmentioning

confidence: 99%

Myoclonus: An Electrophysiological Diagnosis

Merchant

Vial-Undurraga

Leodori

et al. 2020

Movement Disord Clin Pract

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BackgroundBackground: Many different movement disorders have similar "jerk-like" phenomenology and can be misconstrued as myoclonus. Different types of myoclonus also share similar phenomenological characteristics that can be difficult to distinguish solely based on clinical exam. However, they have distinctive physiologic characteristics that can help refine categorization of jerk-like movements. Objectives Objectives: In this review, we briefly summarize the clinical, physiologic, and pathophysiologic characteristics of different types of myoclonus. The methodology and technical considerations for the electrophysiologic assessment of jerk-like movements are reviewed. A simplistic pragmatic approach for the classification of myoclonus and other jerk-like movements based on objective electrophysiologic characteristics is proposed. Conclusions Conclusions: Clinical neurophysiology is an underutilized tool in the diagnosis and treatment of movement disorders. Various jerk-like movements have distinguishing physiologic characteristics, differentiated in the milliseconds range, which is beyond human capacity. We argue that the categorization of movement disorders as myoclonus can be refined based on objective physiology that can have important prognostic and therapeutic implications.The clinical approach to the diagnosis of movement disorders begins with the initial clinical classification of the movements observed based on phenomenology into a discrete number of categories: tremor, myoclonus, chorea, ballism, athetosis, dystonia, spasms, tics, motor stereotypies, and functional. The correct categorization of the movement disorder, or syndrome identification, is a critical first step in arriving at the correct etiological diagnosis. In this article, we address the methodology for improving the clinical characterization of myoclonus, including the pitfalls and challenges. Myoclonus is defined as a syndrome clinically characterized by sudden, brief "jerklike" movements. It can be further classified either as positive, when associated with an active muscle contraction, or negative, when associated with a brief pause in ongoing muscle contraction. [1][2][3] Should any jerk-like movement be called "myoclonus"? Tic disorders, chorea, ballism, dystonia, and functional movements can all have some jerk-like phenomenology. [3][4][5] Tremors, in particular when the frequency is high, can sometimes look like repetitive jerk-like movements and, oppositely, rhythmic myoclonic jerks can be misconstrued as tremor. 3 Startle syndrome commonly

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Segmental Spinal Myoclonus Complicating Lumbar Transforaminal Epidural Steroid Injection

Abstract: Segmental spinal myoclonus is a rare complication after lumbar transforaminal epidural steroid and local anesthetic injection. Pain physicians should be aware of this potential complication.

Cited by 6 publications

References 13 publications

<p>Infection Risk of Lumbar Epidural Injection in the Operating Theatre Prior to Lumbar Fusion Surgery</p>

<p>Infection Risk of Lumbar Epidural Injection in the Operating Theatre Prior to Lumbar Fusion Surgery</p>

A comparison between transforaminal lumbar epidural injection performed under picture archiving and communication systems-based magnetic resonance imaging planning and injection under immediate X-ray guidance

Myoclonus: An Electrophysiological Diagnosis

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