Stellate Ganglion Block Case Report | March 19, 2016
Shawn Tierney, DC, RSMK Musculoskeletal Sonologist | Carol Hanselman, RNP
On March 19th, 2019 patient presented to Joy Wellness Partners (JWP) for the chance to reduce some of his back pain. Patient is 52-year-old male who reported years of excruciating back pain, despite five surgeries, including a spinal fusion in 1993. Patient had previously placed himself on suicide watch, because he developed severe depression from the quality of life reduction that his chronic pain had caused him.
A GE R7 B-mode ultrasound using 8 to 13MHz high frequency GE 12L linear transducer and a 2 to 5.3MHz 4C curvilinear transducer was used by Dr. Shawn Tierney to diagnose the patient’s condition. Patient was diagnosed with lumbar radiculopathy and paraspinal muscle atrophy due to spinal fusion and laminectomy. Additionally, through consultation with NP Carol Bender, patient was diagnosed to be depressed and to have post-traumatic stress syndrome from the multiple surgeries and continuous back pain. The Posttraumatic Stress Disorder (PTSD) Checklist, known as the PCL, was given to the patient, which helps in the diagnosis of PTSD. According to Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5) a score at or above 35 suggests a need for interventional PTSD treatment. The patient’s PCL score pre-right sided stellate was 39, which was diagnostic for PTSD.
A sterile field was prepared, templating was accomplished, doppler was used to identify vascular structures, and a time out was taken to review path and plan for procedure. The probe and area were prepped with hibiclens chlorhexadine solution. Under ultrasound guidance, a needle was guided intrathecally, through the dura, to the spinal canal or subarachnoid space, at the level of the L3 Vertebrae, by NP Carol Bender. Location was confirmed through aspiration of 0.25 mL of CSF, and 1cc XoGlo KM3000 exosomes was injected over 2 minutes into the spinal canal and then flushed with 2 cc normal sterile saline. Needle was removed and a sterile bandage was applied with pressure for 2 minutes.
For the treatment of the depression, and to enhance the effectiveness of the neurologic treatment of exosomes, patient consented to receive a stellate block in addition to the exosomes treatment. Stellate procedure was performed immediately following the exosomes procedure. Needle approach planned by Dr. Shawn Tierney, who examined the anatomy around Chassaignac’s tubercle and the path of the vertebral artery, which was posterior to the C6 anterior tubercle, over the stellate ganglion and radicular arteries, and about the C6 anterior tubercle. Dr. Tierney also confirmed the location of the fascial plane between the longus capitus and longus coli, just anterior to Chassaignac’s tubercle, as well as the path of the C5 and C6 nerve roots. Next, under ultrasound guidance, Carol Bender, NP, injected 8cc 0.5% Ropivacaine around the stellate ganglion on the right side of the neck. Anticipated Horner’s syndrome was achieved within 5 minutes of completion of the block. Patient was observed for any post procedural complications, and none were noted.
Patient felt a major reduction in pain within 24 hours after the treatment. In fact, he was feeling so motivated by the relief of pain that he went on a hike around San Diego 24 hours after the treatment. At his follow up visit with NP Carol Bender a month later, he reported that he went on a road trip around Cuba on bumpy roads and did a lot of walking, yet still felt pain-free after a few days upon return to his home. He was most overjoyed when he could bend down and give his granddaughter a bath in the tub and stand up again without feeling any pain in his back. He reported that he will return to JWP if his pain ever returns, but he has been happily pain-free since the treatment over 12 months ago.
Figure 1. Reduction in Self-Reported Pain on a 1-10 Scale, before and after XoGlo KM3000 Exosomes.
Figure 2. Patient’s Self-Reported PCL-C, before and after the Left and Right-Side Stellate Ganglion Block.