scholarly journals Spontaneous Absorption of a Lumbar Epidural Hematoma after Interlaminar Epidural Steroid Injection in a Patient with Spinal Stenosis

2018 ◽  
Vol 131 (1) ◽  
pp. 117-118 ◽  
Author(s):  
Soo Hyang Kim ◽  
Yun Joung Han ◽  
Young Hoon Kim ◽  
Jae Min Lee ◽  
Yoo Mi Kim ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Epidural Hematoma ◽  
Steroid Injection ◽  
Epidural Steroid Injection ◽  
Interlaminar Epidural Steroid Injection ◽  
Epidural Steroid ◽  
Spontaneous Absorption

Cervical epidural hematoma following interlaminar epidural steroid injection via the contralateral oblique view in patient taking omega-3 fatty acids

2019 ◽  
Vol 44 (2) ◽  
pp. 253-255 ◽  
Author(s):  
Drew Beasley ◽  
Johnathan H. Goree
Keyword(s):  
Fatty Acids ◽  
Epidural Hematoma ◽  
Steroid Injection ◽  
Epidural Steroid Injection ◽  
Omega 3 Fatty Acids ◽  
Omega 3 ◽  
Oblique View ◽  
Anti Inflammatory ◽  
Interlaminar Epidural Steroid Injection ◽  
Epidural Steroid

Background and objectivesWe sought to describe a case of an epidural hematoma after a cervical interlaminar epidural steroid injection (ILESI) performed using contralateral oblique view. We also discuss factors that could have placed this patient at increased risk, including concurrent use of omega-3 fatty acids and non-steroidal anti-inflammatory medications.Case reportA 74-year-old woman returned to the pain clinic, within 15 min of discharge, after an apparent uncomplicated cervical ILESI using the contralateral oblique technique with severe periscapular pain and muscle spasms. Cervical MRI showed a large epidural hematoma which was subsequently emergently evacuated. On postoperative examination, the patient had no neurologic deficits and full resolution of her painful symptoms.ConclusionsTo our knowledge, this is the first reported case of cervical epidural hematoma in which the contralateral oblique technique was used. Also, this is the second case in which the combination of non-steroidal anti-inflammatory medications and omega-3 fatty acids has been considered as a contributor to increased hematoma risk. This case underscores the risk of epidural hematoma using a novel fluoroscopic technique and the need for potential discontinuation of supplements like omega-3 fatty acids.

scholarly journals Clinical Effectiveness and Prognostic Indicators of Parasagittal Interlaminar Epidural Injection

2016 ◽  
Vol 6;19 (6;7) ◽  
pp. E877-E884
Author(s):  
JiHee Hong
Keyword(s):  
Spinal Stenosis ◽  
Beck Depression Inventory ◽  
Steroid Injection ◽  
Clinical Effectiveness ◽  
Prognostic Indicator ◽  
Epidural Steroid Injection ◽  
Leg Pain ◽  
Prognostic Indicators ◽  
Interlaminar Epidural Steroid Injection ◽  
Epidural Steroid

Background: Interlaminar epidural steroid injection (ESI) is a well-established intervention to improve radicular leg pain. However, few studies have demonstrated the prognostic factors for interlaminar ESI. Objective: To investigate the clinical effectiveness and prognostic indicators of parasagittal interlaminar ESI during a 2-week follow-up. Study Design: Prospective evaluation. Setting: An interventional pain management practice in South Korea. Methods: After Institutional Review Board approval, parasagittal interlaminar ESI under fluoroscopic guidance was performed in 55 patients with central spinal stenosis. The numerical rating scale (NRS) and the Oswestry Disability Index (ODI) (%) were used to evaluate clinical efficacy and prognostic indicators. To determine the prognostic indicators, treatment outcomes were classified as successful (decreased NRS ≥ 50%, decreased ODI ≥ 40%) and unsuccessful (decreased NRS < 50%, decreased ODI < 40%) results. Results: Parasagittal interlaminar ESI significantly improved the NRS and ODI (%) scores after 2 weeks compared to those measured pretreatment. Paresthesia provocation (P = 0.006) was a significant prognostic factor on the NRS, whereas the Beck Depression Inventory (BDI) score (P = 0.007), paresthesia provocation (P = 0.035), and epidurography finding (P = 0.038) were significant on the ODI (%) score between patients with successful and unsuccessful outcomes. Limitations: We included the method of parasagittal interlaminar ESI only, therefore, direct comparison with other techniques was not available. Conclusion: Parasagittal interlaminar ESI significantly improved the NRS and ODI (%) scores. Paresthesia provocation was a prognostic indicator on the NRS and ODI (%) scores, and BDI scores and epidurography findings were prognostic indicators for the ODI (%) score. Key words: Parasagittal interlaminar epidural steroid injection, spinal stenosis, radicular leg pain, prognostic indicator, paresthesia provocation, epidurography, Beck Depression Inventory

scholarly journals Spontaneous Resolution of Presumed Acute Epidural Hematoma Formation After Lumbar Epidural Steroid Injection

2017 ◽  
pp. 189-193
Author(s):  
Christopher M. Lam
Keyword(s):  
Spinal Stenosis ◽  
Epidural Hematoma ◽  
Steroid Injection ◽  
Fluid Collection ◽  
Epidural Steroid Injection ◽  
Spinal Epidural Hematoma ◽  
Epidural Steroid Injections ◽  
Lumbar Spinal ◽  
Epidural Steroid ◽  
Spinal Epidural

Epidural steroid injections are interventional pain procedures often used to treat lumbar radicular pain. The most serious complication of this procedure is the formation of a spinal epidural hematoma, which can result in profound permanent neurologic deficits if left untreated. A 76-year-old woman with mild lumbar spinal stenosis (L4-L5, L5-S1) and lumbar dextroscoliosis, previously on 81mg of aspirin daily (discontinued at 14 days prior to procedure) and not on anticoagulation therapy, underwent a lumbar epidural steroid injection (T12-L1). Post-procedurally, she developed bilateral leg paralysis. A magnetic resonance imaging (MRI) study revealed a fluid collection concerning for hematoma. Neurosurgery was consulted, but at the time of evaluation, she had near resolution of her presenting symptoms and the decision was made to monitor her for 48 hours. Three months after discharge, MRI revealed no persistent symptoms or radiographic evidence of sequelae from epidural hematoma. The frequency of spinal epidural hematomas after epidural steroid injections is unknown. This patient did not have traditional risk factors of severe spinal stenosis or the use of anticoagulant or antiplatelet agents. A radiographic fluid collection was seen, which may represent blood or persistent injectate. A formal surgical diagnosis was not obtained, as her symptoms spontaneously improved without further need for intervention. We report the first case of presumed persistent injectate compression of the lumbar spinal cord, resulting in bilateral lower extremity weakness in a patient with dextroscoliosis, mimicking spinal epidural hematoma with spontaneous resolution without intervention. Key words: Epidural steroid injection, spinal epidural hematoma, dextroscoliosis, lumbar radiculopathy, spinal stenosis, lower extremity paralysis

Sign in / Sign up

Export Citation Format

Share Document