Undiagnosed Vertebral Hemangioma Causing a Lumbar Compression Fracture and Epidural Hematoma in a Parturient Undergoing Vaginal Delivery Under Epidural Analgesia: A Case Report

Abstract

(Can J Anesth. (2015) 62:901–906) Vertebral hemangiomas are benign vascular tumors that tend to develop within the vertebra and occur in roughly 10% of the population. These tumors do not typically grow quickly and do not cause any symptoms as long as they remain within the vertebra. However, if these tumors grow beyond the spine’s bony structures, they can produce symptoms related to nerve root compression or compression of the spinal cord. Similarly aggressive development of vertebral hemangiomas can become apparent in pregnant patients, especially during the third trimester when previously undiagnosed tumors may begin to cause a number of neurological symptoms, including radicular pain, sensory and motor deficits, and incontinence. This article details an atypical case in which vertebral hemangiomas resulted in a vertebral fracture that presented at first as postpartum back pain following epidural analgesia. The patient in question was a 32-year-old North African pregnant woman who was at 40+4 weeks gestation. She had previously experienced 3 uncomplicated deliveries without epidural analgesia. At 162 cm in height and weighing 96 kg, she had gained roughly 27 kg during this pregnancy, which was significantly more than what she had gained with her other pregnancies. The patient did not have a history of back pain or trauma and did not suffer from any neurological or coagulation disorders. She had never received general or neuraxial anesthesia before this pregnancy.