From the *Neuroanesthesia and Neurocritical Care, Swedish Medical Center, Seattle; †Physician Anesthesia Service, Seattle; ‡Radiology, Swedish Neuroscience Institute, Swedish Medical Center, Seattle; and §Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA.
Reg Anesth Pain Med. 2014 Jan-Feb;39(1):78-80. doi: 10.1097/AAP.0000000000000025.
One risk with placement of an epidural blood patch (EDBP) is spinal cord or nerve root compression resulting from the epidural blood volume injected, a complication necessitating immediate surgical decompression. We could not find a previous report of this in the literature. Here, we review and discuss one such case.
A patient was treated with 2 EDBPs for a presumptive cerebrospinal fluid leak 3 weeks after an epidural steroid injection. The second EDBP was performed under direct fluoroscopic guidance, yet resulted in spinal cord compression with radiologic evidence of an epidural hematoma. The patient developed acute cauda equina syndrome and required an emergent decompressive laminectomy resulting in partial resolution of neurological symptoms. One year after the procedure, the patient has recovered most of her motor function but with some persistent numbness below the left knee and a left foot drop.
A cauda equina syndrome from an epidural hematoma may occur as a rare complication of an EDBP, even with direct fluoroscopic guidance. Early diagnosis of symptoms and prompt surgical evacuation of an epidural hematoma is essential and may result in the resolution of symptoms. This complication remains a rare occurrence and should not deter the performance of an EDBP, when indicated.
硬膜外血补丁（EDBP）的放置存在一个风险，即由于注射的硬膜外血量导致脊髓或神经根受压，这是一种需要立即手术减压的并发症。我们在文献中未找到之前对此的报道。在此，我们回顾并讨论了这样一个病例。
一名患者在硬膜外类固醇注射后 3 周因疑似脑脊液漏接受了 2 次 EDBP 治疗。第 2 次 EDBP 在直接荧光透视引导下进行，但导致脊髓受压，并出现硬膜外血肿的放射学证据。患者出现急性马尾综合征，需要紧急减压椎板切除术，导致部分神经症状缓解。手术后 1 年，患者已恢复大部分运动功能，但左膝以下仍有一些持续性麻木和左脚下垂。
即使在直接荧光透视引导下，硬膜外血肿引起的马尾综合征也可能是 EDBP 的罕见并发症。早期诊断症状并及时手术清除硬膜外血肿至关重要，可能会使症状得到缓解。这种并发症仍然很少见，不应阻止在需要时进行 EDBP。
