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Spinal myoclonus following neuraxial anesthesia: a literature review

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Abstract

Spinal myoclonus (SM) is a rare neurologic movement disorder following neuraxial anesthesia (NA). SM following NA (SM-NA) has insufficient clinical information and its pathogenesis remains to be elucidated. The aim of this review article was to summarize the past cases and consider SM-NA pathophysiology. Based on our PubMed search, it was revealed that SM-NA develops within several hours after neuraxial local anesthetic (LA) administration and resolves in a day without leaving neurologic compilations. It occurs primarily in the lower extremities, but can sometimes spread upward and affect the upper extremities and trunk. Although statistical adjustments are indispensable, analysis of the previous cases provided important facts that seem to be related with the mechanism of SM-NA. The frequently used LAs for spinal anesthesia were hyperbaric. SM-NA occurrence was more frequent in women. After initiation of spinal anesthesia, intrathecal hyperbaric LA distributes cephalad. In the LA elimination process, the large concentration differences in intrathecal LA may induce the partially functioning spinal neurons, resulting in myoclonus generation. The morphological features of the lumbar spine in women can predispose to a higher LA concentration difference. SM-NA is an unpredictable and rare neural complication following NA and should be confirmed by basic experiments and large-scale researches.

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Acknowledgements

This research did not receive any specific grants from funding agencies in the public, commercial, or not-for-profit sectors. We gratefully acknowledge Toyomi Kamesaki (Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University). The authors also thank the Clinical Research Support Team Jichi (CRST) in Jichi Medical University for their advice.

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Authors and Affiliations

  1. Department of Anesthesiology, Ina Central Hospital, 1313-1 Koshiroukubo, Ina, Nagano, 396-8555, Japan

    Tohru Shiratori

  2. Department of Anesthesiology and Critical Care Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan

    Kunihisa Hotta & Masaaki Satoh

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  1. Tohru Shiratori
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  2. Kunihisa Hotta
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  3. Masaaki Satoh
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TS, KH, and MS wrote the manuscript. KH and MS revised the manuscript. KH supervised this work. TS prepared manuscript files. All authors reviewed and approved the final manuscript for submission.

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Correspondence to Tohru Shiratori.

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Shiratori, T., Hotta, K. & Satoh, M. Spinal myoclonus following neuraxial anesthesia: a literature review. J Anesth 33, 140–147 (2019). https://doi.org/10.1007/s00540-018-02607-z

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