title: A patient who received 191 spinal anesthetics over 5 years without evidence of neurologic complications by examination or magnetic resonance imaging.
abstract: We present the case of a 50-year-old man who suffered a crush injury to his right lower extremity in 2002 and received 191 spinal anesthetics to date with no identifiable neurologic complications by physical examination or imaging. He has undergone >300 operations at our institution related to recurrent infection and wound breakdown, including multiple amputations and debridements with 146 of these occurring in a span of 36 months. The patient has no focal neurologic deficits involving his right lower extremity and denies any associated pain or paresthesias. Magnetic resonance imaging of the patient's lumbar spine performed in September of 2009 revealed fibrotic changes, consistent with scar tissue formation, over the L2 and L3 spinous processes. There was no evidence of intrathecal scar tissue, adhesions, neuroma formation, or other changes that could be attributed to repeated lumbar puncture. Although uneventful in our single patient, safety with respect to the development of transient or permanent neurologic complications, infections, or subclinical pathology identified by imaging cannot be broadly extrapolated to repeat lumbar punctures.
authors.affiliation: From the Departments of *Anesthesiology, Perioperative and Pain Medicine and †Radiology, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Joshua C
authors.initials: JC
authors.lastname: Vacanti
authors.forename: Aaron
authors.initials: A
authors.lastname: Sodickson
authors.forename: Bhavani S
authors.initials: BS
authors.lastname: Kodali
mesh_terms: D000775:Anesthesia, Spinal / Q000009:adverse effects; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D035002:Lower Extremity / Q000294:innervation*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D059348:Peripheral Nerve Injuries / Q000601:surgery / Q000628:therapy*; D010808:Physical Examination; D011237:Predictive Value of Tests; D012086:Reoperation; D013997:Time Factors
chemical_list: D000779:Anesthetics, Local