ABSTRACT
A 49-year-old male patient presented at our clinic with back pain due to an insignificant injury that had occurred approximately 7 months earlier. Although the patient had been treated at primary clinics, the pain had gradually become aggravated and characterized by resting and night pain. We initially diagnosed the patient with myofascial pain syndrome and began treatment comprised of trigger point injection (TPI) on the back muscles to control the pain. His symptoms improved after the first treatment (TPI), but he complained of back pain again several days later. At that time he also reported that he had lost 10 kg over the 4 months preceding his initial visit. Plain radiographs of the thoracolumbar spine revealed L1-L5 compression fractures and generalized osteopenia. The patient was then diagnosed with multiple myeloma based on the results of a bone marrow biopsy. This case demonstrates the importance of using comprehensive diagnostic approaches when the patient manifests symptoms that are unresponsive to conventional treatment.
Subject(s)
Humans , Male , Middle Aged , Back Pain , Biopsy , Bone Diseases, Metabolic , Bone Marrow , Fractures, Compression , Low Back Pain , Multiple Myeloma , Muscles , Myofascial Pain Syndromes , Spine , Trigger PointsABSTRACT
A 72-year-old man undergoing emergency arthroscopic irrigation and debridement of the left knee joint due to pyogenic arthritis developed cauda equina syndrome after spinal anesthesia with 0.5% hyperbaric tetracaine mixed with epinephrine. Epinephrine was added to local anesthetic to prolong the duration and to increase the quality of spinal anesthesia. There was no paresthesia on needle placement. We injected anesthetics twice because the first subarachnoid injection failed. The patient experienced impaired sensation in the perineal region and alterations in bowel and urinary habits. Magnetic resonance imaging revealed spondylolisthesis and disc protrusion (L4-5), with spinal stenosis (L5-S1), but did not show suspicious lesions such as hematoma and abscess. We suggest the causative factors are temporary neural compression due to his spinal diseases and spinal cord ischemia due to decreased spinal blood flow because of epinephrine. We also cannot rule out the tetracaine neurotoxicity.