Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
Reg Anesth Pain Med. 2019 Feb;44(2):253-255. doi: 10.1136/rapm-2018-000005.
We sought to describe a case of an epidural hematoma after a cervical interlaminar epidural steroid injection (ILESI) performed using contralateral oblique view. We also discuss factors that could have placed this patient at increased risk, including concurrent use of omega-3 fatty acids and non-steroidal anti-inflammatory medications.
A 74-year-old woman returned to the pain clinic, within 15 min of discharge, after an apparent uncomplicated cervical ILESI using the contralateral oblique technique with severe periscapular pain and muscle spasms. Cervical MRI showed a large epidural hematoma which was subsequently emergently evacuated. On postoperative examination, the patient had no neurologic deficits and full resolution of her painful symptoms.
To our knowledge, this is the first reported case of cervical epidural hematoma in which the contralateral oblique technique was used. Also, this is the second case in which the combination of non-steroidal anti-inflammatory medications and omega-3 fatty acids has been considered as a contributor to increased hematoma risk. This case underscores the risk of epidural hematoma using a novel fluoroscopic technique and the need for potential discontinuation of supplements like omega-3 fatty acids.
我们旨在描述一例在使用对侧斜位进行颈椎椎间孔硬膜外类固醇注射（ILESI）后发生硬膜外血肿的病例。我们还讨论了可能使该患者面临更高风险的因素，包括同时使用ω-3 脂肪酸和非甾体抗炎药。
一名 74 岁女性在接受对侧斜位技术进行看似无并发症的颈椎 ILESI 后 15 分钟内返回疼痛诊所，出现严重的肩胛间疼痛和肌肉痉挛。颈椎 MRI 显示硬膜外血肿较大，随后紧急进行了血肿清除。术后检查时，患者无神经功能缺损，疼痛症状完全缓解。
据我们所知，这是首例报道的使用对侧斜位技术发生颈椎硬膜外血肿的病例。此外，这是第二例同时考虑非甾体抗炎药和 ω-3 脂肪酸联合使用增加血肿风险的病例。该病例强调了使用新型透视技术发生硬膜外血肿的风险，以及需要考虑停用 ω-3 脂肪酸等补充剂。
