Spinal Epidural Hematoma after Pain Control Procedure

Abstract

J Korean Neurosurg Soc 48 : [281][282][283][284] 2010 Spinal epidural hematoma is a rare complication associated with pain control procedures such as facet block, acupuncture, epidural injection, etc. Although it is an uncommon cause of acute myelopathy, and it may require surgical evacuation. We report four patients with epidural hematoma developed after pain control procedures. Two procedures were facet joint blocks and the others were epidural blocks. Pain was the predominant initial symptom in these patients while two patients presented with post-procedural neurological deficits. Surgical evacuation of the hematoma was performed in two patients while in remaining two patients, surgery was initially recommended but not performed since symptoms were progressively improved. Three patients showed near complete recovery except for one patient who recovered with residual deficits. Although, spinal epidural hematoma is a rare condition, it can lead to serious complications like spinal cord compression. Therefore, it is important to be cautious while performing spinal pain control procedure to avoid such complications. Surgical treatment is an effective option to resolve the spinal epidural hematoma.

Spontaneous Epidural Hematoma of the Cervical Spine Mimicking a Cerebrovascular Accident: A Case Report

“…Some authors include hematomas secondary to coagulopathy, vascular malformations, hemorrhagic tumors and also pain control procedures. 2,3 Other authors claim, however, that hematoma can be labeled as spontaneous only when it is of idiopathic origin. 2 Patients often present with a sudden onset of back or neck pain around the affected vertebrae, with corresponding dermatomal radiculopathy, which then rapidly progresses to symptoms and signs of spinal cord compression.…”

Spinal Subarachnoid Hematoma as a Complication of an Intramuscular Stimulation : Case Report and a Review of Literatures

“…IMS was developed in 1973 and has proven to be an effective treatment for chronic pain, including myofascial pain syndrome7,11). Because the needle is very thin (diameter : 0.25-0.4 mm) and has a rounded tip, IMS has relatively few side effects5) and can be safely used for most patients, except those with local infection at the treatment site, uncontrolled diabetes mellitus, or increased bleeding tendency.…”

Spinal epidural hematoma following removal of incorrectly placed jugular central venous catheter

“…[1][2][3]5,8,9,11,12 Most notably, a spinal epidural hematoma following epidural catheter anesthesia has been reported to occur at a frequency of 1 in 150,000 to 1 in 190,000 anesthetized cases, and many such hematomas occur after catheter tube removal. [1][2][3]5,8,9 Regarding the mechanism underlying the development of a spinal epidural hematoma, because the venous plexus in the epidural space dorsal to the spinal cord is valveless and thin-walled, slight changes in venous pressure or mild mechanical stress can readily trigger bleeding of this plexus. [1][2][3]8 The fact that most spinal epidural hematomas develop dorsal to the spinal cord also supports the theory that the vertebral venous plexus is the main bleeding source of these hematomas.…”