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| 21KF-033 |
Acute Cervical Hematoma After Interlaminar Cervical Epidural block
Department of Anesthesiology and Pain Medicine, Kangdong and Kangnam Sacred Heart Hospital, Hallym University college of Medicine, Seoul, Korea
Cervical herniated intervertebral disk(HIVD) is a common condition that many pain clinicians face in daily practice and cervical translaminar epidural block is one of the most reliable methods of treating variety of chronic benign pain syndromes, including cervical radiculopathy, cervicalgia, postlaminectomy syndrome, compression fractures, postherpetic neuralgia. Although most of these procedures are performed safely without serious complications under fluoroscopic or ultrasound guidance, we experienced an unusual case of epidural hematoma.
A 62-year-old female was diagnosed with cervical herniated intervertebral disk of C6-7 level. No other diagnosis has been made for her, and she has not taken any anticoagulant, antiplatelet or vasodilating drugs. Laboratory tests including complete blood count, coagulation, platelet function test and CRP were performed, which were all within normal range. We performed translaminar cervical epidural injection of right C6-7 level under fluoroscopic guidance. During the entire procedure, aspiration of blood was not detected. After 6 hour, she abruptly felt right-sided neck pain and limited range of motion when rotating her neck. The patient also told us that she could not move her right arm and right leg freely and urinate or defecate. She came back to our office and thorough neurologic examination was carried out. Right side weakness of motor grade 4 and voiding difficulty were detected. Suspecting epidural hematoma, we went down to MRI suite with the patient for emergency imaging. Spinal epidural hematoma extending from right C2 to T1 level was confirmed on the MRI and emergency decompressive laminectomy was immediately scheduled with neurosurgery department. C5-6 total laminectomy and C7 upper laminectomy with hematoma removal was carried out with microscopy. Few days later, the patient was discharged and regular outpatient follow up is now going on.
Our conclusion is that severe spinal stenosis, increased epidural pressure may cause epidural hematoma even though there are not any risk factors such as anticoagulant medications, bleeding diathesis. As a result, cautious and slow advancement of needle and injection of fluid is crucial in preventing epidural hematoma. Excessive amount of fluid injected into the epidural space may also cause increased pressure, though exact quantity is still to be further investigated.
A 62-year-old female was diagnosed with cervical herniated intervertebral disk of C6-7 level. No other diagnosis has been made for her, and she has not taken any anticoagulant, antiplatelet or vasodilating drugs. Laboratory tests including complete blood count, coagulation, platelet function test and CRP were performed, which were all within normal range. We performed translaminar cervical epidural injection of right C6-7 level under fluoroscopic guidance. During the entire procedure, aspiration of blood was not detected. After 6 hour, she abruptly felt right-sided neck pain and limited range of motion when rotating her neck. The patient also told us that she could not move her right arm and right leg freely and urinate or defecate. She came back to our office and thorough neurologic examination was carried out. Right side weakness of motor grade 4 and voiding difficulty were detected. Suspecting epidural hematoma, we went down to MRI suite with the patient for emergency imaging. Spinal epidural hematoma extending from right C2 to T1 level was confirmed on the MRI and emergency decompressive laminectomy was immediately scheduled with neurosurgery department. C5-6 total laminectomy and C7 upper laminectomy with hematoma removal was carried out with microscopy. Few days later, the patient was discharged and regular outpatient follow up is now going on.
Our conclusion is that severe spinal stenosis, increased epidural pressure may cause epidural hematoma even though there are not any risk factors such as anticoagulant medications, bleeding diathesis. As a result, cautious and slow advancement of needle and injection of fluid is crucial in preventing epidural hematoma. Excessive amount of fluid injected into the epidural space may also cause increased pressure, though exact quantity is still to be further investigated.
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