Introduction

Ganglion impar block (GIB) is a well-recognised treatment for chronic coccydynia. Several side effects have previously been described with this procedure, including transient motor dysfunction, bowel, bladder, and sexual dysfunction, neuritis, rectal perforation, impingement of the sciatic nerve, cauda equina syndrome, and infection.

Case presentation

We describe the first report of imaging-documented conus infarction after an unguided-GIB performed in theatre using particulate steroids for a 17-year-old patient with coccydynia. Immediately post-GIB, patient developed transient neurological deficits in her lower limbs of inability to mobilise her legs that lasted for 24 h. These include back and leg pain, decreased power and movement, increased tone, brisk reflexes, reduced light touch sensation and proprioception of legs up to the T10 level. Urgent MRI spine showed intramedullary hyperintense signal within the conus and mild restricted diffusion on the distal cord and conus, suggestive of an acute conus infarction. On follow-up, the GIB did not result in symptom improvement of coccydynia and there was persistent altered sensation of her legs.

Discussion

Various approaches of ganglion impar block have been described and performed in the past with different imaging techniques and injectants. A few cases of unusual neurological complications have been reported with the use of epidural steroid injections and ganglion impar block. Clinicians should be aware of the possible neurological complications following ganglion impar blocks and the risk of inadvertent intravascular injection of particulate steroids can potentially to be minimised by using imaging guidance.

中文翻译：

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使用颗粒类固醇治疗慢性尾骨痛的非引导经尾骨神经节障碍阻滞后圆锥梗塞。

介绍

神经节障碍阻滞 (GIB) 是一种公认​​的慢性尾骨痛治疗方法。此前已经描述过该手术的几种副作用，包括短暂的运动功能障碍、肠、膀胱和性功能障碍、神经炎、直肠穿孔、坐骨神经撞击、马尾综合征和感染。

案例展示

我们描述了第一份影像记录的圆锥梗塞报告，该报告是在手术室对一名 17 岁尾尾痛患者使用颗粒类固醇进行非引导 GIB 后发生的。GIB 后，患者立即出现下肢短暂神经功能缺损，无法活动腿部，持续 24 小时。这些症状包括背部和腿部疼痛、力量和运动能力下降、音调增加、反射敏捷、轻触感和腿部本体感觉减弱（最高可达 T10 水平）。紧急 MRI 脊柱显示圆锥内髓内高信号，远端脊髓和圆锥上轻度受限扩散，提示急性圆锥梗塞。随访中，GIB 并未导致尾骨痛症状改善，并且腿部感觉持续改变。

讨论

过去已经描述并使用不同的成像技术和注射剂进行神经节撞击阻滞的各种方法。据报道，使用硬膜外类固醇注射和神经节障碍阻滞时出现了一些不寻常的神经并发症。临床医生应意识到神经节损伤阻滞后可能出现的神经并发症，并且通过使用影像引导可以将无意的血管内注射颗粒类固醇的风险降至最低。