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Original research
Literature review of spinal hematoma case reports: causes and outcomes in pediatric, obstetric, neuraxial and pain medicine cases
  1. Honorio T Benzon1,
  2. Ariana M Nelson2,
  3. Arpan G Patel1,
  4. Silvia Chiang2,
  5. Deepti Agarwal1,
  6. Hubert A Benzon3,
  7. Jack Rozental4 and
  8. Robert J McCarthy5
  1. 1Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
  2. 2Department of Anesthesiology, University of California Irvine, Irvine, California, USA
  3. 3Department of Anesthesiology, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
  4. 4Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  5. 5Department of Anesthesiology, Rush Medical College of Rush University, Chicago, Illinois, USA
  1. Correspondence to Dr Honorio T Benzon, Anesthesiology, Feinberg School of Medicine, Chicago, Illinois, USA; hobenzon{at}nm.org

Abstract

Background The risk of spinal epidural hematoma (SEH) has been described in the literature but the impact in various patient populations has not been assessed in the same study. We identified the risk factors for SEH and calculated the OR for recovery in the pediatric, adult and obstetric (OB) patients based on the degree of neurological deficit before surgery.

Methods Adult non-OB cases were categorized whether they were on anticoagulants or not; SEH was related to neuraxial or pain procedure; or whether there was adherence to the American Society of Regional Anesthesia (ASRA) guidelines. Eligible cases were identified through PubMed and Embase searches in the English literature from 1954 to July 2022.

Results A total of 940 cases were evaluated. In the pediatric cases, SEH was typically spontaneous, related to coagulopathy or athletic trauma. OB cases were spontaneous or related to neuraxial injections. Among adults on anticoagulant(s), SEH was mostly spontaneous with no related etiology or related to neuraxial procedure. SEH occurred despite adherence to the ASRA guidelines. Among non-OB adults not on anticoagulants, SEH was due to trauma, neuraxial injections, surgery or other causes. Neurological recovery was related to the degree of neurological deficit before surgery.

Conclusions Our data show a preponderance of spontaneous SEH in all patient populations. SEH developed even though the ASRA guidelines were followed, especially in patients on multiple anticoagulants. Patients with less impairment prior to surgery had a higher likelihood of complete recovery, regardless of the interval between surgery and onset of symptoms.

  • Anticoagulants
  • Injections, Spinal
  • Pediatrics
  • Obstetrics
  • OUTCOMES

Data availability statement

Data are available upon reasonable request. References related to instances of spinal hematoma in relation to specific situations are available on request. Additional data are included within the article as supplemental materials.

https://doi.org/10.1136/rapm-2023-105161

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    Data availability statement

    Data are available upon reasonable request. References related to instances of spinal hematoma in relation to specific situations are available on request. Additional data are included within the article as supplemental materials.

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    Footnotes

    • Twitter @ANels_MD

    • Contributors All authors satisfy the requirements for coauthorship. Honorio T Benzon is responsible for the overall content as the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.