A 60-year-old male with a past history of T12 fracture had epidural analgesia for a radical prostatectomy. It was unknown prior to epidural insertion that the patient had a canal stenosis at T12 from the previous injury. The patient developed severe bilateral buttock pain after epidural catheter removal. Magnetic resonance imaging demonstrated a spinal subdural haematoma from T10 to L2 with mild cord compression. The patient made a successful recovery with conservative management. Neuraxial blockade should be approached with caution in patients with previous back injury, and only after a thorough assessment has been obtained to exclude spinal canal stenosis.
JenkinsK., BakerA.B.Consent and anaesthetic risk.Anaesthesia2003; 58: 962–984.
2.
HorlockerT.T.What's a nice patient like you doing with a complication like this? Diagnosis, prognosis and prevention of spinal hematoma.Can J Anesth2004; 51: 527–534.
3.
GuayJ.Estimating the incidence of epidural hematoma— Is there enough information?Can J Anesth2004; 51: 514–515.
4.
HorlockerT.T., WedelD.J., BenzonH.Regional anesthesia in the anticoagulated patient: defining the risks (the second ASRA consensus conference on neuraxial anesthesia and anticoagulation).Reg Anesth Pain Med2003; 28: 172–197.
5.
SchwarzS.K.W., WongC.L., McDonaldW.N.Spontaneous recovery from a spinal epidural hematoma with atypical presentation in a nonagenarian.Can J Anesth2004; 51: 557–561.
6.
WulfH.Epidural anaesthesia and spinal haematoma.Can J Anesth1996; 43: 1260–1271.
7.
VandermeulenE.P., Van AkenH., VermylenJ.Anticoagulants and spinal-epidural anesthesia.Anesth Analg1994; 79: 1165–1177.
8.
CullenD.J., BogdanovE., HtutN.Spinal epidural hematoma occurrence in the absence of known risk factors: a case series.J Clin Anesth2004; 16: 376–381.
9.
BraunwaldE., FauciA.S., KasperD.L., HauserS.L., LongoD.L., JamesonJ.L., eds. Harrison's principles of internal medicine.15th ed.New York: McGraw-Hill Medical Publishing Division2001; 83.
10.
ChaudhariL.S., KopB.R., DhruvaA.J.Paraplegia and epidural analgesia.Anaesthesia1978; 33: 722–725.
11.
MoenV., DahlgrenN., IrestedtL.Severe neurological complications after central neuraxial blockades in Sweden 1990–1999.Anesthesiology2004; 101: 950–959.
StamboughJ.L., StamboughJ.B., EvansS.Acute cauda equina syndrome after total knee arthroplasty as a result of epidural anesthesia and spinal stenosis.J Arthroplasty2000; 15: 375–379.
SchwartzF.T., MohammedA., SartawiM.D., FoxJ.L.Unusual hematomas outside the spinal cord. Report of two cases.J Neurosurg1973; 39: 249–251.
16.
MorandiX., RiffaudL., ChabertE., BressierG.Acute non-traumatic spinal subdural hematomas in three patients.Spine2001; 26: E547–E551.
17.
LangmayrJ.J., OrtlerM., DesslA., TwerdyK., AichnerF., FelberS.Management of spontaneous extramedullary spinal haematomas: results in eight patients after MRI diagnosis and surgical decompression.J Neurol Neurosurg Psychiatry1995; 59: 442–447.
18.
HainesD.E., HarkeyH.L., Al-MeftyO.The ‘subdural’ space: A new look at an outdated concept.Neurosurgery1993; 32: 111–120.
19.
DomenicucciM., RamieriA., CiappettaP., DelfiniR.Non-traumatic acute spinal subdural hematoma. Report of five cases and review of the literature.J Neurosurg (Spine)1999; 91: 65–73.
20.
FoxJ.Spinal and epidural anesthesia and anticoagulation.Int Anesthesiol Clin2001; 39: 51–61.
21.
KreppelD., AntoniadisG., SeelingW.Spinal hematoma: a literature survey with meta-analysis of 613 patients.Neurosurg Rev2003; 26: 1–49.
22.
GroenR.J.M.Non-operative treatment of spontaneous spinal epidural hematomas: a review of the literature and comparison with operative cases.Acta Neurochir (Wien)2004; 146: 103–110.
