Acute Epidural Hematoma Occurring After Removal of Percutaneous Spinal Cord Stimulator Trial Leads in a Cancer Patient with Chronic Thrombocytopenia: A Case Report

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