Epidural hematoma after caudal epidural pulsed radiofrequency stimulation: A case report

Neuraxial and Perineural Bleeding after Neuraxial Techniques: An Overview of the Last Year

Spinal hematoma following neuraxial or perineural techniques is a rare but severe complication that can potentially lead to catastrophic consequences. The aim of this review is to analyze all reported cases of neuraxial or perineural bleeding after performance of a locoregional technique since the last guidelines update in 2018. We included articles indexed by MEDLINE, Scopus, and Google Scholar. We analyzed the patient's age, surgical procedure, pre-operative anticoagulant and antiplatelet therapy, type of anesthetic procedure, vertebra level of the procedure, diameter and point type of the needle, hematoma type (spinal, subdural, epidural), signs and symptoms, time to imaging, and time to treatment and outcome. During our bibliographic research, we identified 5637 unique articles that were eligible according to our protocol criteria, identifying 18 separate cases of neuraxial bleeding. Although clinicians are usually aware of antiplatelet and anticoagulant perioperative management, a careful post-procedural observation and a detailed patient education are also imperative for the early detection of the symptoms of spinal cord ischemia.

Epidural Hematoma After Trans-Sacral Epiduroscopic Laser Decompression: A Case Report

Objective: In this study, we report a patient who developed lumbar epidural hematoma after trans-sacral epiduroscopic laser decompression (SELD). Background: SELD is a nonoperative minimally invasive spinal procedure, in which a herniated lumbar disk can be ablated by laser. Because of the rich epidural venous plexus, the procedure might have a risk of epidural hematoma. Materials and methods: A 57-year-old woman underwent the SELD procedure for the treatment of lower back and right buttock pain due to disk protrusion at L5-S1. One day after the procedure, complete motor weakness was observed in the right leg. Results: Lumbar magnetic resonance imaging revealed epidural hematoma at the L1-L5 levels, compressing the thecal sac. Using a posterior approach, decompressive subtotal laminectomy on L1 and total laminectomy on L2-L5 with evacuation of the hematoma were performed. Two months postoperatively, near complete resolution of the motor weakness in the right leg was observed. Conclusions: Clinicians should keep in mind the likelihood of epidural hematoma after SELD.