Perineural Hematoma Following Lumbar Transforaminal Steroid Injection Causing Acute‐on‐Chronic Lumbar Radiculopathy: A Case Report

Abstract

Although extremely rare, perineural or foraminal hematomas may occur as a serious complication of TFESI, even in the setting of a standardized procedure. Hematoma may cause worsening of symptoms in the acute and subacute phase following TFESI. Further investigation into the etiologies of such injuries is warranted and must be added to the considerations of pain physicians performing these procedures.

Optimal Angle of Needle Insertion for Fluoroscopy‐Guided Transforaminal Epidural Injection of L5

“…Inaccurate needle insertion during epidural injection may cause various complications, including infection and perineural hematoma . Therefore, accurate insertion of the needle at the target site is important.…”

“…Inaccurate needle insertion during epidural injection may cause various complications, including infection and perineural hematoma. [11][12][13][14] Therefore, accurate insertion of the needle at the target site is important. For this reason, epidural steroid injection under fluoroscopic guidance has been used preferentially, and clinicians can confirm whether drugs are accurately injected at the target site by monitoring the flow of contrast medium along the nerve root sheath.…”

Epidural Complications and troubleshooting

“…A case of perineural hematoma following lumbar TF infiltration has also been described in a female patient without predisposing factors. 35 According to a study documenting vascular incidents in pain management procedures, thrombotic events are 3 times more frequent than bleeding phenomena are (162 vs 55 cases, respectively). Among the thrombotic events, 153 occurred after suspending anticoagulant medication and 9 after suspending antiplatelet therapy.…”

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

“…[4,5] However, one of the devastating complications of TFESI is epidural hematoma, which can lead to serious neurologic sequelae and can occur even though it is performed with appropriate skill under fluoroscopic guidance. [6] The prevalence of epidural hematoma after epidural anesthesia is around 1/150,000, but prevalence after TFESI has not been studied. [7] In pain practice, spinal hematoma complication is rare after epidural injection, and there are few case reports where epidural hematoma occurs elsewhere in the injection site.…”