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经椎间孔硬膜外注射部位远处发生的脊髓硬膜外血肿：一例报告。

Spinal epidural hematoma occurring at a distance from the transforaminal epidural injection site: A case report.

作者信息

Kim Sang-In, Lee Dong-Hyun, Kim Sun-Hee, Cho Yong-Hyun

机构信息

Department of Anesthesiology and Pain Medicine, Seoul Sacred Heart General Hospital, Seoul, Korea.

出版信息

Medicine (Baltimore). 2019 Jul;98(30):e16654. doi: 10.1097/MD.0000000000016654.

DOI:10.1097/MD.0000000000016654
PMID:31348320
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6709172/
Abstract

RATIONALE

Transforaminal epidural steroid injection (TFESI) is a conservative method to treat back pain due to radiculopathy. However, epidural hematoma can occur after the procedure by various mechanisms, which can cause serious complications.

PATIENT CONCERNS

An 82-year-old man with spinal stenosis was treated with TFESI in the right intervertebral foramen at the L2-L3 level. The next morning, he experienced severe back pain and diffuse motor deficit.

DIAGNOSIS

Emergency magnetic resonance imaging revealed fluid collection in the posterior epidural space at the T11-L1 level with central-canal stenosis.

INTERVENTIONS

Emergency hematoma evacuation was performed to remove the epidural hematoma.

OUTCOMES

After the surgery, the back pain disappeared.

LESSONS

Epidural hematoma may occur due to causes other than direct needle injury after TFESI. Therefore, careful observation of the patient is necessary after the procedure.

摘要

理论依据

经椎间孔硬膜外类固醇注射（TFESI）是治疗神经根病所致背痛的一种保守方法。然而，该手术后可通过多种机制发生硬膜外血肿，这可能导致严重并发症。

患者情况

一名82岁的腰椎管狭窄男性患者在L2-L3水平的右侧椎间孔接受了TFESI治疗。次日清晨，他出现了严重的背痛和弥漫性运动功能障碍。

诊断

急诊磁共振成像显示T11-L1水平的硬膜外后间隙有积液，伴有中央管狭窄。

干预措施

进行了急诊血肿清除术以清除硬膜外血肿。

结果

手术后，背痛消失。

经验教训

TFESI后硬膜外血肿可能由直接针刺损伤以外的原因引起。因此，术后需要对患者进行仔细观察。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7db5/6709172/946402bcdbc3/medi-98-e16654-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7db5/6709172/bacaa811c509/medi-98-e16654-g001.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7db5/6709172/c3262eeaa504/medi-98-e16654-g003.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7db5/6709172/7dfa94b79ec0/medi-98-e16654-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7db5/6709172/946402bcdbc3/medi-98-e16654-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7db5/6709172/bacaa811c509/medi-98-e16654-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7db5/6709172/813c65deec99/medi-98-e16654-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7db5/6709172/c3262eeaa504/medi-98-e16654-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7db5/6709172/3bb09b01cb7b/medi-98-e16654-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7db5/6709172/7dfa94b79ec0/medi-98-e16654-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7db5/6709172/946402bcdbc3/medi-98-e16654-g006.jpg

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Sciatica.坐骨神经痛
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