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Interventional Spinal Procedures in the Presence of a Chiari Malformation: A Potential Contraindication

Smith, Jason A. MD; Cuccurullo, Sara J. MD; Protzman, Nicole M. MS; Kooch, Jason E. DO

American Journal of Physical Medicine & Rehabilitation: August 2014 - Volume 93 - Issue 8 - p 714–718
doi: 10.1097/PHM.0000000000000099
Case Reports

ABSTRACT Although Chiari malformations are much more prevalent than once believed, no study has described treatment with an interventional spinal procedure. The purpose of this report was to discuss the clinical course of a patient who was diagnosed with a Chiari malformation and treated with three cervical epidural injections. In 2012, a 50-yr-old woman presented to a neurology clinic with chronic suboccipital headaches, diplopia, and increasing numbness/tingling in her upper extremities. Magnetic resonance imaging confirmed a type I Chiari malformation and a cervical syrinx. The patient was treated with three cervical epidural injections, after which her symptoms exacerbated. Consequently, a posterior fossa suboccipital craniectomy with C1 laminectomy and excision of extradural and intradural adhesions was performed. After surgical intervention, notable neurologic improvements were observed. Given the marked worsening of symptoms, the present report suggests that interventional spinal procedures may be a contraindication in the presence of a Chiari malformation with a syrinx.

From the JFK Johnson Rehabilitation Institute, Edison, New Jersey (JAS, SJC); and Physical Medicine & Rehabilitation (JAS, JEK) and Clinical Education & Research Department (NMP), Coordinated Health, Bethlehem, Pennsylvania (JAS, NMP, JEK).

All correspondence and requests for reprints should be addressed to: Nicole M. Protzman, MS, Clinical Education & Research Department, Coordinated Health, 2300 Highland Avenue, Bethlehem, PA.

Presented as a poster at the Association of Academic Physiatrists (AAP) 2012 Annual Meeting.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

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