Castillo J, Santiveri X, Escolano F, Castaño J
Servicio de Anestesiología y Reanimación, Hospital Mar-Esperança, (Institut Municipal d'Assistència Sanitaria), Barcelona.
Rev Esp Anestesiol Reanim. 2003 Dec;50(10):504-9.
Spinal cord compression from a hematoma is a rare serious complication of neuroaxial anesthesia. Our objective was to investigate cases reported and published by Spanish authors.
Cases of spinal cord compression related to neuroaxial hematomas (epidural, subarachnoid, or both) reported at congreses and meetings in Spain or published in Medline-indexed journals from 1989 through December 2002 were reviewed. The clinical characteristics, risk factors, treatments, and outcomes were described for each case.
Since 1996, when the first cases were reported, 20 cases in all have appeared: 8 related to sub-arachnoid anesthesia, 8 to epidural anesthesia, 1 to a combination, and 1 to diagnostic lumbar puncture. In 2 cases, the neuroaxial technique used was poorly defined. Factors that might have caused the complication could be identified in 11 cases, among which there were 7 cases of anesthetic puncture or manipulation of an epidural catheter during a period of hemorrhagic risk because of antithrombotic therapy. The hematoma was evacuated surgically in 11 cases, and medical treatment was provided in 9 cases. The neurologic outcome was satisfactory in 14 cases.
The number of compressive spinal hematomas reported or published by Spanish authors is fairly high, and there are cases related to both sub-arachnoid and epidural anesthesia. Nonsurgical treatment was provided in 45% of the cases and the outcome was satisfactory in 70%. Risk factors were identified in over half of the reported cases.
血肿导致的脊髓压迫是神经轴索麻醉罕见的严重并发症。我们的目的是调查西班牙作者报告和发表的病例。
回顾了1989年至2002年12月在西班牙的会议上报告的或发表在被Medline收录期刊上的与神经轴索血肿（硬膜外、蛛网膜下或两者均有）相关的脊髓压迫病例。描述了每个病例的临床特征、危险因素、治疗方法及结果。
自1996年首例病例报告以来，共出现20例：8例与蛛网膜下麻醉有关，8例与硬膜外麻醉有关，1例与联合麻醉有关，1例与诊断性腰椎穿刺有关。2例中神经轴索技术使用情况不明确。11例中可确定可能导致并发症的因素，其中7例是在抗血栓治疗导致出血风险期间进行麻醉穿刺或硬膜外导管操作。11例手术清除血肿，9例进行药物治疗。14例神经功能结果满意。
西班牙作者报告或发表的压迫性脊髓血肿数量相当多，且有与蛛网膜下和硬膜外麻醉相关的病例。45%的病例采用非手术治疗，70%的病例结果满意。超过半数的报告病例中确定了危险因素。
