Spinal cord compression caused by hematoma related to neuroaxial anesthesia in Spain
Castillo, J.; Santiveri, X.; Escolano, F.; Castaño, J.
Revista Espanola de Anestesiologia y Reanimacion 50(10): 504-509
2003
ISSN/ISBN: 0034-9356 PMID: 14737776 Document Number: 557386
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.