J Korean Soc Emerg Med.  2013 Aug;24(4):459-463.

Cervical Epidural Hematoma Following a Facet Joint Nerve Block

• Choi JH
• Cho YS
• Kim HJ

Abstract

Facet joint nerve blocks is the most commonly utilized interventions in managing chronic spinal pain. A fluoroscopically directed facet joint nerve block for pain management may result in a rare complication of spinal epidural hematoma causing acute myelopathy. Although this complication is well-known with epidural anesthesia (where it is usually seen with impaired hemostasis), there are surprisingly few case reports of epidural hematoma after a facet joint nerve block. We report here a case of a 58-year-old man, with no evidence of coagulopathy and not taking antiplatelet medication, having a sudden onset of acute cervical myelopathy from a large cervical epidural hematoma one hour after a facet joint nerve block. Following prompt surgical evacuation of the clot, the patient made a nearly complete recovery. Spinal epidural hematoma after spinal puncture is usually associated with impaired hemostasis. However, this case illustrates that it may occur in the absence of known risk factors. The delayed onset and the absence of risk factors have implications for the use of this procedure in chronic pain management.

Keyword

Spinal epidural hematoma; Nerve block; Pain management

MeSH Terms

Anesthesia, Epidural
Chronic Pain
Hematoma
Hematoma, Epidural, Spinal
Hemostasis
Humans
Middle Aged
Nerve Block
Pain Management
Risk Factors
Spinal Cord Diseases
Spinal Puncture
Zygapophyseal Joint