Iatrogenic spinal hematoma as a complication of lumbar puncture: What is the risk and best management plan?

Abstract

Background:Lumbar puncture (LP) rarely results in complications such as spinal hematomas. However, it remains unclear if certain variables increase likelihood of these events, or if surgical intervention improves outcome.Methods:In addition to two clinical vignettes, we evaluated the post-1974 literature for cases of spinal hematoma and subsequent intervention. Based on our compilation of data, we evaluated outcome relative to numerous distinct variables.Results:Based on 35 LP-related spinal hematoma cases in the post-1974 literature and our encounters, we found 28.6% of patients presenting with preexisting coagulopathy had poor outcomes regardless of intervention, relative to 14.3% of patients without coagulopathy; a highly significant difference (P = 0.02). Once diagnosed, 21 patients were treated surgically and 14 nonsurgically. Of the 60% surgical patients, 57.1% had good outcomes, and 42.9% had poor outcomes within 12 months. Of 40% nonsurgical patients, 57.1% had good outcomes and 42.9% had poor outcomes. Results in these groups were not statistically different.Conclusions:We found a significant correlation between preexisting coagulopathy and poor neurological outcome irrespective of intervention. However, outcomes for these patients may be confounded by comorbidities including underlying conditions contributing to their coagulopathy. No significant correlation between type of surgical intervention and good outcome was found, possibly attributable to the paucity of details in existing case reports and the difficulty defining the degree of spinal cord compromise from a given lesion. Despite our findings, emergent neurosurgical intervention may be beneficial for the management of complications such as cauda equina syndrome secondary to intrathecal spinal hematoma.

A spinal subdural hematoma induced by guidewire-based lumbar drainage in a patient with ruptured intracranial aneurysms

“…A direct correlation between rapid deterioration of symptoms and recovery, as well as the time to definitive intervention, has been established [5]. Preexisting coagulopathy correlated significantly with a poor neurological outcome, irrespective of the intervention [1].…”

“…Furthermore, no significant correlation was established between the type of surgical intervention and good outcome, based on a previous report. However, the emergent neurosurgical intervention was suggested to manage complications such as cauda equina syndrome induced by intrathecal spinal hematoma [1]. In this patient, hematoma evacuation and spinal canal decompression were performed promptly after MRI confirmation.…”

“…Severe complications such as spinal hematoma formation that could lead to myelopathy or cauda equina syndrome are rarely observed; such complications should be diagnosed and treated immediately to avoid irreversible paralysis or death. However, existing reports have not produced efficient solutions, and prevention of such complications is rarely mentioned [1].…”

Unexpected intrathecal haemorrhage following uncomplicated placement and removal of an epidural catheter

“…Overall comparison of surgical v s non-surgical intervention revealed no significant difference in outcomes. 5…”

Massive lumbar spine hematoma post-spinal tap

“…However, LP is still associated with serious complications that are often discounted due to low incidence. [ 1 ] A good example is the development of spinal hematoma. In clinical practice, few carry out postprocedural investigation for spinal hematoma unless the patient reports sensory or motor changes after the procedure.…”