Fish oil has been anecdotally linked to bleeding
complications during interventional spinal
procedures. We present a case report involving
a cervical epidural hematoma following cervical
epidural injection in a patient who has been taking
fi sh oil, with detailed literature review.
A 49-year-old woman with a previous history of
anterior cervical disc fusion at C5-C6 underwent
routine cervical epidural injection for neck pain
due to a disc herniation below her fusion. Thirty
minutes after the procedure, she experienced
numbness and tingling in both arms and developed
severe pain between her shoulder blades.
She was sent to the emergency room and soon
developed a left-sided wrist drop. An emergent
cervical magnetic resonance image (MRI) revealed
an epidural hematoma at C6-C7. She
underwent emergent surgical decompression of
the hematoma through multiple laminectomies at
C6, C7, and T1. The surgeon noticed excessive
blood oozing through the incision site and left
two drains in the wound. She recovered without
neurological defi cit. Upon further investigation,
it was discovered that she had been taking high
doses of over-the-counter fi sh oil.
Ingredients in over-the-counter preparations
are not regulated or standardized. Fish oil use
may predispose a patient to bleeding complications
when used in higher doses alone or when
used at any dose in conjunction with antiplatelet
therapy. The benefi ts of fi sh oil use should be
weighed against the potential risk of bleeding with
cessation of fi sh oil in patients undergoing spinal
interventions. As described by others, signifi cant
pain at the site of injection which is unusual and
different from the pain experienced in the past as
well as complicating factor of loss of resistance
technique in closed space must be considered.
Finally, rapid diagnosis and intervention avoids
neurological defi cit.
Key words: Fish oil, omega-3, aspirin, cervical
epidural steroid injection, complication, epidural
hematoma, literature review
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