title: Three cases of hemiplegia after cervical paraspinal muscle needling.
abstract: BACKGROUND
  Muscle needling therapy is common for chronic pain management, but the development of unusual complications such as hemiplegia is not well understood.
  
  
  OBJECTIVE
  We report on three cases with hemiplegia after cervical paraspinal muscle needling and propose possible explanations for these unusual complications.
  
  
  METHODS
  Case report.
  
  
  METHODS
  The 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.
  
  
  RESULTS
  A 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.
  
  
  CONCLUSIONS
  Spinal 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.
authors.affiliation: Depatment of Neurosurgery, Spine and Spinal Cord Research Institute, Yonsei University, College of Medicne, 50 Yonsei-ro, Seodamun-gu, 120-752 Seoul, Korea; Department of Neurosurgery, Guro Teun Teun Hospital, 547 Siheungdae-ro, Guro-gu, 152-880 Seoul, Korea.
authors.forename: Gyu Yeul
authors.initials: GY
authors.lastname: Ji
authors.affiliation: Department of Neurosurgery, Guro Teun Teun Hospital, 547 Siheungdae-ro, Guro-gu, 152-880 Seoul, Korea.
authors.forename: Chang Hyun
authors.initials: CH
authors.lastname: Oh
authors.affiliation: Department of Neurosurgery, Guro Teun Teun Hospital, 547 Siheungdae-ro, Guro-gu, 152-880 Seoul, Korea.
authors.forename: Won-Seok
authors.initials: WS
authors.lastname: Choi
authors.affiliation: Department of Neurosurgery, Korea University Anam Hospital, College of Medicine, 73, Inchon-ro, Seongbuk-gu, 136-705 Seoul, Korea. Electronic address: jblee42@gmail.com.
authors.forename: Jang-Bo
authors.initials: JB
authors.lastname: Lee
mesh_terms: D015670:Acupuncture Therapy / Q000009:adverse effects*; D000328:Adult; D066193:Cervical Cord / Q000293:injuries*; D005260:Female; D046748:Hematoma, Epidural, Spinal / Q000150:complications / Q000209:etiology* / Q000601:surgery; D006429:Hemiplegia / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007796:Laminectomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D064170:Paraspinal Muscles; D056910:Republic of Korea; D012189:Retrospective Studies
keywords: Bleeding dynamics; Cervical; Complication; Needling therapy; Pain management; Spinal hematoma