Epidural Hematoma Development Contralateral To Dura After Lumbar Transforaminal Epidural Steroid Injection

Güngör, Semih; Aiyer, Rohit

doi:10.2217/pmt-2017-0012

Cited by 15 publications

(6 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the case reported by Choi et al, [13] epidural hematoma occurred at the L2-L4 level after caudal block. In the cases reported by Gungor and Arier, [14] post-TFESI contralateral epidural hematoma occurred in the direction of injection. In the above 3 cases, warfarin or antiplatelet drugs were implicated but in our case, the patient was not taking any anticoagulant or antiplatelet drugs.…”

Section: Discussionmentioning

confidence: 99%

Spinal epidural hematoma occurring at a distance from the transforaminal epidural injection site

Kim¹,

Lee²,

Kim³

et al. 2019

Medicine

View full text Add to dashboard Cite

Rationale: Transforaminal epidural steroid injection (TFESI) is a conservative method to treat back pain due to radiculopathy. However, epidural hematoma can occur after the procedure by various mechanisms, which can cause serious complications. Patient concerns: An 82-year-old man with spinal stenosis was treated with TFESI in the right intervertebral foramen at the L2-L3 level. The next morning, he experienced severe back pain and diffuse motor deficit. Diagnosis: Emergency magnetic resonance imaging revealed fluid collection in the posterior epidural space at the T11-L1 level with central-canal stenosis. Interventions: Emergency hematoma evacuation was performed to remove the epidural hematoma. Outcomes: After the surgery, the back pain disappeared. Lessons: Epidural hematoma may occur due to causes other than direct needle injury after TFESI. Therefore, careful observation of the patient is necessary after the procedure.

show abstract

Section: Discussionmentioning

confidence: 99%

Spinal epidural hematoma occurring at a distance from the transforaminal epidural injection site

Kim¹,

Lee²,

Kim³

et al. 2019

Medicine

View full text Add to dashboard Cite

show abstract

“…Moderate and severe central canal stenosis at the L5/S1 level is relatively uncommon compared to at the L2/L3, L3/4, and L4/5 levels (27). While there have been cases of symptomatic epidural hematomas at sites remote from the location of the procedure needle, this is not a common phenomenon (24,(28)(29)(30). Thus, while epidural hematomas may or may not be unusual in the setting of caudal ESIs, we hypothesize that when they do develop, they are less likely to be clinically relevant than those in the lumbar spine where ESIs are typically performed at or very close to sites of significant neural compression.…”

Section: Total Percent Of Totalmentioning

confidence: 99%

Caudal Epidural Steroid Injections in the Setting of Remaining on Antithrombotics: A Retrospective Study

et al. 2021

View full text Add to dashboard Cite

BACKGROUND: The American Society of Regional Anesthesia currently recommends ceasing antithrombotic medications for all spinal epidural steroid injections, however there is a paucity of data on the true risk of spinal epidurals via various approaches versus the risk of cessation of an agent as it relates to the underlying medical condition. OBJECTIVE: This study evaluated the complication rate of caudal epidural steroid injections in patients who remain on antithrombotic medications. STUDY DESIGN: Retrospective chart review. SETTING: Physiatric Spine Clinic in Orthopedic Specialty Office and Surgical Center. METHODS: A retrospective chart review was performed identifying patients (n = 335) who received a caudal epidural steroid injection (n = 673) from June 2015 through April 2020. Patients were included if they had received the injection while taking an antithrombotic medication. Patients were excluded if they were not taking an antithrombotic. The patient’s age, indication for the injection including magnetic resonance imaging or computed tomography findings, antithrombotic medication, the medical condition requiring an antithrombotic, and any complications following the injection were collected via chart review. RESULTS: Of the 443 injections included in the study, 51 encounters were lost to follow-up. Of the other 392 injections, there were no reported complications, regardless of the patient’s imaging findings, age, the antithrombotic medication used, or the underlying medical condition for which an antithrombotic medication was indicated. LIMITATIONS: This is a retrospective study. Therefore, a prospective study may have yielded fewer encounters lost to follow-up. Patients were not contacted directly after the procedure and chart reviews were utilized to evaluate for complications, which was limited to a patient’s reporting of perceived complications without any imaging. CONCLUSIONS: We conclude that caudal epidural steroid injections can be performed safely in patients while taking antithrombotic medications. Catastrophic events have been observed in patients who have discontinued antithrombotic agents preceding procedures. Thus, discontinuing antithrombotic medications may pose a greater risk than benefit for patients on an antithrombotic medication who have painful lumbar radiculopathy. KEY WORDS: Epidural injection, caudal, antithrombotic, safety, steroids, anticoagulant, antiplatelet, epidural hematoma

show abstract

“…One case resulted in a foraminal/subarticular hematoma with transient monoradiculopathy (6). The other 2 cases were associated with small epidural hematomas without clinically significant sequalae and of unclear temporal and spatial relation to the injections performed (7,8). None of the case reports described the use of a satisfactory technique.…”

Section: Caution When Withholding Antithrombotic and Antiplatelet Agents For Interventional Spine Procedures And The Need For Further Rismentioning

confidence: 99%

Caution When Withholding Antithrombotic and Antiplatelet Agents for Interventional Spine Procedures and the Need for Further Risk Stratification

Miller¹,

Schneider

McCormick

2019

Pain Phys

View full text Add to dashboard Cite

Epidural Hematoma Development Contralateral To Dura After Lumbar Transforaminal Epidural Steroid Injection

Abstract: This is the first reported case of an epidural hematoma on the contralateral side of the dura at a distance from the needle tip location, in the setting of severe central canal stenosis.

Cited by 15 publications

References 17 publications

Spinal epidural hematoma occurring at a distance from the transforaminal epidural injection site

Spinal epidural hematoma occurring at a distance from the transforaminal epidural injection site

Caudal Epidural Steroid Injections in the Setting of Remaining on Antithrombotics: A Retrospective Study

Caution When Withholding Antithrombotic and Antiplatelet Agents for Interventional Spine Procedures and the Need for Further Risk Stratification

Contact Info

Product

Resources

About