Three cases of hemiplegia after cervical paraspinal muscle needling

Background contextMuscle needling therapy is common for chronic pain management, but the development of unusual complications such as hemiplegia is not well understood.PurposeWe report on three cases with hemiplegia after cervical paraspinal muscle needling and propose possible explanations for these unusual complications.Study designCase report.MethodsThe authors retrospectively reviewed the medical charts from a decade (2002-2013) at Korea University Hospital. The records were systematically searched, and the cases with hemiplegia (grade<3) after needing therapy were collected. No conflict of interest reported. No funding received.ResultsA 54-year-old woman, a 38-year-old woman, and a 60-year-old man with hemiplegia by cervical subdural or epidural hematoma after cervical posterior paraspinal muscle needling without direct invasion (intramuscular stimulation, acupuncture, or intramuscular lidocaine) were observed. All patients were taken for emergent decompressive laminectomy, and their postoperative motor function improved substantially.ConclusionSpinal hematoma after muscle needling is unusual but was thought to result after a rupture of the epidural or subarachnoid veins by a sharp increase in blood pressure delivered in the intraabdominal or intrathoracic areas after needling therapy.