BACKGROUND CONTEXT: Muscle needling therapy is common for chronic pain 
management, but the development of unusual complications such as hemiplegia is 
not well understood.
PURPOSE: We report on three cases with hemiplegia after cervical paraspinal 
muscle needling and propose possible explanations for these unusual 
complications.
STUDY DESIGN: Case report.
METHODS: The authors retrospectively reviewed the medical charts from a decade 
(2002-2013) at Korea University Hospital. The records were systematically 
searched, and the cases with hemiplegia (grade<3) after needing therapy were 
collected. No conflict of interest reported. No funding received.
RESULTS: A 54-year-old woman, a 38-year-old woman, and a 60-year-old man with 
hemiplegia by cervical subdural or epidural hematoma after cervical posterior 
paraspinal muscle needling without direct invasion (intramuscular stimulation, 
acupuncture, or intramuscular lidocaine) were observed. All patients were taken 
for emergent decompressive laminectomy, and their postoperative motor function 
improved substantially.
CONCLUSION: Spinal hematoma after muscle needling is unusual but was thought to 
result after a rupture of the epidural or subarachnoid veins by a sharp increase 
in blood pressure delivered in the intraabdominal or intrathoracic areas after 
needling therapy.