Subdural Thoracolumbar Spine Hematoma after Spinal Anesthesia: A Rare Occurrence and Literature Review of Spinal Hematomas after Spinal Anesthesia.

Prasanthi Maddali,Vicki Diaz,Marc Moisi,Christian Fisahn,Blake Walker,R Shane Tubbs,Rod J Oskouian,Jeni Page,Michael E Zwillman

doi:10.7759/cureus.1032

Abstract

Spinal hematomas are a rare but serious complication of spinal epidural anesthesia and are typically seen in the epidural space; however, they have been documented in the subdural space. Spinal subdural hematomas likely exist within a traumatically induced space within the dural border cell layer, rather than an anatomical subdural space. Spinal subdural hematomas present a dangerous clinical situation as they have the potential to cause significant compression of neural elements and can be easily mistaken for spinal epidural hematomas. Ultrasound can be an effective modality to diagnose subdural hematoma when no epidural blood is visualized. We have reviewed the literature and present a full literature review and a case presentation of an 82-year-old male who developed a thoracolumbar spinal subdural hematoma after spinal epidural anesthesia. Anticoagulant therapy is an important predisposing risk factor for spinal epidural hematomas and likely also predispose to spinal subdural hematomas. It is important to consider spinal subdural hematomas in addition to spinal epidural hematomas in patients who develop weakness after spinal epidural anesthesia, especially in patients who have received anticoagulation.

Highlights

BackgroundSpinal canal hematomas have long been recognized as lesions capable of producing sudden spinal cord and/or cauda equina compression [1-19]
Spinal hematomas are a rare but serious complication of spinal epidural anesthesia and are typically seen in the epidural space; they have been documented in the subdural space
We have reviewed the literature and present a full literature review and a case presentation of an 82-year-old male who developed a thoracolumbar spinal subdural hematoma after spinal epidural anesthesia

Summary

Introduction

Spinal canal hematomas have long been recognized as lesions capable of producing sudden spinal cord and/or cauda equina compression [1-19]. White arrow shows edema in the thoracic spinal cord He was emergently transferred to our hospital, and on neurological exam, he was found to have a T10 sensory level and motor exam consistent with 0-1/5 in his right lower extremity and 0/5 in his left lower extremity. An electron microscopy study by Haines, et al recently offered explanations for subdural hematoma occurrence in the brain, which seem plausible for the spine [33] According to these authors, the dura is composed externally of elongated flattened fibroblasts and large amounts of extracellular collagen; internally, it is made up of flattened fibroblasts and extracellular spaces containing no extracellular collagen, with few cell junctions. According to Haines, et al, it is not difficult to imagine that in patients with preexisting coagulopathy, this layer is more prone to rupture especially after the trauma of an attempted spinal anesthesia has occurred [33]

Conclusions

Disclosures

13. Pear BL