{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T08:59:36Z","timestamp":1776848376272,"version":"3.51.2"},"reference-count":7,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"C","license":[{"start":{"date-parts":[[2024,6,1]],"date-time":"2024-06-01T00:00:00Z","timestamp":1717200000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2024,6,1]],"date-time":"2024-06-01T00:00:00Z","timestamp":1717200000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2024,4,19]],"date-time":"2024-04-19T00:00:00Z","timestamp":1713484800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction and importance:<\/jats:title>\n                    <jats:p>While the typical symptom associated with pneumorachis after an epidural block is radiculopathy in one or several corresponding segments, there has been a rare case report of significant complications such as cardiac arrest leading to death, or paraplegia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation:<\/jats:title>\n                    <jats:p>We present a case of an eighty-nine-year-old male patient who developed progressive paraplegia following an upper thoracic epidural block-associated pneumorachis. The procedure was performed at a different hospital using the loss of resistance (LOR) technique. Interestingly, the onset of paraplegia was delayed, occurring six hours after the procedure. Furthermore, there was a discrepancy between the clinical symptoms and the identified lesion in imaging studies. Despite the performance of an emergency laminectomy to remove the epidural gas, the paralysis continued to progress proximally.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical discussion:<\/jats:title>\n                    <jats:p>Healthcare professionals should observe patients for an appropriate duration after the procedure to detect and manage any delayed symptoms. And it is crucial to recognize the potential for lesion extension beyond the symptomatic segment and perform thorough imaging examinations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>These findings emphasize the importance of exercising caution during the procedure, even when using a minimal amount of air with the LOR technique in the thoracic spine.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Highlights<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1016\/j.ijscr.2024.109669","type":"journal-article","created":{"date-parts":[[2024,4,21]],"date-time":"2024-04-21T18:05:52Z","timestamp":1713722752000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Progressive paraplegia after upper thoracic epidural block-related pneumorachis: A case report"],"prefix":"10.1097","volume":"119","author":[{"given":"Kyu-Bok","family":"Kang","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Veterans Health Service Medical Center, 53, Jinhwangdoro 61-gil, Gangdong-gu, Seoul 05368, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Youngbae B.","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Veterans Health Service Medical Center, 53, Jinhwangdoro 61-gil, Gangdong-gu, Seoul 05368, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Young Bin","family":"Shin","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Veterans Health Service Medical Center, 53, Jinhwangdoro 61-gil, Gangdong-gu, Seoul 05368, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sam Soon","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Veterans Health Service Medical Center, 53, Jinhwangdoro 61-gil, Gangdong-gu, Seoul 05368, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eun Dong","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Veterans Health Service Medical Center, 53, Jinhwangdoro 61-gil, Gangdong-gu, Seoul 05368, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"issue":"1","key":"R1-27-20260422","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.surneu.2004.09.047","article-title":"Case report and review of the literature","volume":"64","author":"Chibbaro","year":"2005","journal-title":"Surg. Neurol."},{"issue":"Suppl. 5","key":"R2-27-20260422","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1007\/s00586-006-0160-6","article-title":"Pathogenesis, diagnosis and management of pneumorrhachis","volume":"15","author":"Oertel","year":"2006","journal-title":"Eur. Spine J."},{"issue":"1","key":"R3-27-20260422","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1186\/s13256-018-1908-4","article-title":"Cardiac arrest associated with pneumorrhachis and pneumocephalus after epidural analgesia: two case reports","volume":"12","author":"Shin","year":"2018","journal-title":"J. Med. Case Rep."},{"issue":"1","key":"R4-27-20260422","doi-asserted-by":"crossref","first-page":"66","DOI":"10.4097\/kjae.2016.69.1.66","article-title":"Paraplegia following cervical epidural catheterization using loss of resistance technique with air: a case report","volume":"69","author":"Chae","year":"2016","journal-title":"Korean J. Anesthesiol."},{"issue":"2","key":"R5-27-20260422","doi-asserted-by":"crossref","first-page":"181","DOI":"10.3344\/kjp.2006.19.2.181","article-title":"Vertebral spreading segments of cervical epidural injection: a comparative study with 5 ml and 10 ml of injected volume","volume":"19","author":"Lee","year":"2006","journal-title":"The Korean Journal of Pain"},{"issue":"6","key":"R6-27-20260422","doi-asserted-by":"crossref","first-page":"521","DOI":"10.3340\/jkns.2014.56.6.521","article-title":"Radicular compression by intraspinal epidural gas bubble occurred in distant two levels after lumbar microdiscectomy","volume":"56","author":"Lee","year":"2014","journal-title":"Journal of Korean Neurosurgical Society"},{"issue":"5","key":"R7-27-20260422","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1097\/JS9.0000000000000373","article-title":"The SCARE 2023 guideline: updating consensus surgical CAse REport (SCARE) guidelines","volume":"109","author":"Sohrabi","year":"2023","journal-title":"Int J Surg Lond Engl."}],"container-title":["International Journal of Surgery Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2210261224004504?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2210261224004504?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.lww.com\/10.1016\/j.ijscr.2024.109669","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T08:03:08Z","timestamp":1776844988000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1016\/j.ijscr.2024.109669"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6]]},"references-count":7,"journal-issue":{"issue":"C","published-print":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.1016\/j.ijscr.2024.109669","relation":{},"ISSN":["2210-2612"],"issn-type":[{"value":"2210-2612","type":"print"}],"subject":[],"published":{"date-parts":[[2024,6]]},"assertion":[{"value":"2024-02-14","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-04-19","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}