Selective cervical nerve root block is usually executed for patients who have symptoms of cervical radiculopathy for diagnostic and therapeutic purposes. or treatment for cervical radiculopathy. It can be executed even in a case where cervical radiculopathy is not resolved after surgery such as in cervical discectomy or interbody fusion procedures. According to a report encompassing 1,036 cases of performing continuous fluoroscopic-guided extraforaminal cervical nerve blocks [1] and a prospective study by Pobiel et al. [2], selective cervical nerve root block was described as a relatively safe 913358-93-7 manufacture operation. However, there have been reported crucial neurological complications related to this operation such as anterior spinal artery syndrome or cerebral infarction [3]. In addition, the possibility of post-operative anatomical 913358-93-7 manufacture changes will be expected to increase such risk. We observed an episode of the incidence and recovery of hypoesthesia and motor paralysis of limb in a patient who underwent a C5 selective Rabbit Polyclonal to BL-CAM (phospho-Tyr807). cervical nerve root block to treat his persistent post-operative cervical radiculopathy. Case Report A 43-year-old male patient with cerebral palsy (athetoid type) was diagnosed with cervical disc herniation in addition to a symptom of 1-year history of pain radiating to the upper limb. The patient underwent a laminectomy (C3-5), an anterior interbody fusion (C3-5), a posterior 913358-93-7 manufacture interbody fusion (C3-5), and an artificial bone graft operation 1 year ago. However, he complained of persistent pain mediated by the branch of the left C5 after the operations. He was then referred to the Pain Clinic of our hospital for inpatient collaborative consultation for treatment. At that time, his visual analogue scale (VAS) score was an 8 out of 10. After due consideration that it was difficult to perform interlaminar epidural block because of the inability to put the patient in the appropriate position and that the stellate ganglion block had no effect, a left C5 selective cervical nerve root block was performed. Monitoring devices were set to measure the patient’s electrocardiogram (EKG), blood pressure (BP), and arterial oxygen saturation (SpO2). He was placed into the supine position and the puncture area was disinfected with the broad application of betadine solution on the neck and was covered with a sterile gauze dressing. Under continuous radiography, while having the neck held to the anterior-superior and adjusting c-arm fluoroscopy to 45 degrees, a needle was advanced via the anterolateral approach. When a 5 cm-block needle reached the superior articular process of the left C5 and was advanced to the neural groove, care was taken to confirm that placement of the needle tip did not across the halfway point of the posterior cervical articulate pillar. After injection of 1 1.5 ml contrast medium, radicular and epidural contrasts were confirmed, but vascular or intraspinal contrasts were not observed (Fig. 1). When the patient complained of paresthesia caused by injection needles, a mixed solution of 3 ml 1% mepivacaine and 40 mg triamcinolone was infused. Prior to the infusion, no body fluids such as regurgitated blood or cerebrospinal fluid were observed with aspiration. Fig. 1 An anterior-posterior view of cervical spine during C5 nerve root injection. The needle lies in the C5-6 intervertebral foramen after injection of 1 1 ml contrast medium. The needle is not advanced no further than halfway across facet column. The contrast … Approximately 2 minutes after administration, the patient felt weak in the right arm as well as the left arm, however when his motor ability was grade 3 of 5 in 913358-93-7 manufacture both upper limbs, all senses regarding pain, temperature, and position disappeared. One minute later, the motor ability of both upper limbs was entirely gone, immediately followed by disappearance of the sensation and motor ability of the lower limbs, and the patient complained of labored respiration. At that time, his BP was 150/90 mmHg, SpO2 at pulse oximetry was 98%, and EKG indicated a normal sinus rhythm. As his anxiety.