Background: While the possibility of spinal
epidural hematoma (SEH) has been considered
a complication of removal of spinal cord stimulator
(SCS) leads, acute hematoma has not been
described in the oncologic population.
Objectives: We describe concerns of neuraxial
procedures in cancer patients. This population
represents a unique subset of patients as thrombocytopenia,
as well as platelet dysfunction, are
common complications of cancer and chemotherapy.
The literature regarding the assessment
and management of thrombocytopenia in patients
undergoing neuraxial techniques is reviewed.
Study Design: Case report.
Setting: A major academic cancer hospital, Memorial
Sloan Kettering Cancer Center.
Methods: We report a case of acute SEH occurring
in a patient 5 minutes after removal of SCS
trial leads. The patient has a history of chronic
thrombocytopenia and lymphoma.
Results: Although the patient’s trial leads were
placed without incident and platelets were “corrected”
with transfusions, she presented with
acute back pain and headache. Computed tomography
(CT) imaging confirmed an epidural
hematoma, which clinically resolved and led to
no long-term sequelae.
Limitations: Retrospective design, no possibility
to establish a cause-effect relationship, and
subject to risk of over-interpretation.
Conclusions: We present a patient experiencing
symptoms of acute neuraxial bleeding immediately
following removal of SCS trial leads. The patient’s
chronic thrombocytopenia was attributed to
splenic sequestration, and therefore, was treated
with platelet transfusions. The patient, however,
had several risk factors for platelet dysfunction,
as well. The use of point-of-care platelet function
assays, such as platelet function analyzer and
viscoelastic methodologies, would have perhaps
helped to better elucidate the bleeding risk in this
patient and help guide management. The discovery
of platelet dysfunction would have precluded
our patient from neuromodulation.
Key words: Spinal cord stimulation, epidural
hematoma, removal of spinal cord stimulator
leads, dorsal column stimulation, acute epidural
hematoma
Acute epidural hematoma due to spinal venous angioma: A case report
