Anesth Pain Med.  2021 Apr;16(2):184-190. 10.17085/apm.20085.

Epidural hematoma treated by aspiration after transforaminal epidural steroid injection - A case report -

• Kim GE
• Hong SJ
• Kang SS
• Ki HJ
• Park JH

• KMID: 2515545
• DOI: http://doi.org/10.17085/apm.20085

Abstract

Background
Spinal epidural hematoma is rare condition that can rapidly develop into severe neurologic deficits. The pathophysiology of this development remains unclear. There are several case reports of emergency hematoma evacuations after epidural steroid injection. Case: We report on two patients who developed acute, large amounts of epidural hematoma without neurological deficits after transforaminal epidural steroid injection. After fluoroscopy guided aspiration for epidural hematoma was performed, neurological defects did not progress and the hematoma was shown to be absorbed on magnetic resonance imaging.
Conclusions
These reports are believed to be the first of treating epidural hematoma occurring after transforaminal epidural steroid injection through non-surgical hematoma aspiration. If large amounts of epidural hematoma are not causing neurological issues, it can be aspirated until it is absorbed.

Keyword

Aspiration; Epidural injection; Low back pain; Magnetic resonance imaging; Nonsurgical; Spinal epidural hematoma; Spinal stenosis

Figure

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  Fig. 1. (A, B) The contrast was injected and spread well in the anterior epidural space (white arrows).

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  Fig. 2. (A–D) T1- and T2-weighted sagittal and axial MRI images showing the 14-centimeter epidural hematoma (white arrows) at the T11-L4 level. MRI: magnetic resonance imaging.

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  Fig. 3. (A, B) T2-weighted sagittal and axial MRI images showing a decrease in the epidural hematoma (white arrows) and nerve compression. MRI: magnetic resonance imaging.

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  Fig. 4. (A, B) AP/lat. fluoroscopy image showing the anterior epidural space spreading (white arrows).

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  Fig. 5. (A, B) T2-weighted sagittal MRI image showing a large amount of epidural hematoma (white arrows) at the lower T-L spine and clumping of cauda equina at the L1-2 level. (C) T2-weighted axial MRI image at the L1 level showing epidural hematoma and nerve compression (white arrow). MRI: magnetic resonance imaging.

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  Fig. 6. (A, B) A total of 5 ml of diluted blood aspirated through an epidural catheter.

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  Fig. 7. (A, B) T2-weighted sagittal and axial MRI images showing decreased epidural hematoma (white arrow) and nerve compression. MRI: magnetic resonance imaging.

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