• Journal of Korean Neurosurgical Society
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• v.48 no.3
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• pp.281-284
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• 2010

Spinal epidural hematoma is a rare complication associated with pain control procedures such as facet block, acupuncture, epidural injection, etc. Although it is an uncommon cause of acute myelopathy, and it may require surgical evacuation. We report four patients with epidural hematoma developed after pain control procedures. Two procedures were facet joint blocks and the others were epidural blocks. Pain was the predominant initial symptom in these patients while two patients presented with post-procedural neurological deficits. Surgical evacuation of the hematoma was performed in two patients while in remaining two patients, surgery was initially recommended but not performed since symptoms were progressively improved. Three patients showed near complete recovery except for one patient who recovered with residual deficits. Although, spinal epidural hematoma is a rare condition, it can lead to serious complications like spinal cord compression. Therefore, it is important to be cautious while performing spinal pain control procedure to avoid such complications. Surgical treatment is an effective option to resolve the spinal epidural hematoma.

• Journal of Korean Neurosurgical Society
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• v.49 no.4
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• pp.231-233
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• 2011

Chronic spinal epidural hematoma related to Kummell's disease is extremely rare. An 82-year-old woman who had been managed conservatively for seven weeks with the diagnosis of a multi-level osteoporotic compression fracture was transferred to our institute. Lumbar spine magnetic resonance images revealed vertebral body collapse with the formation of a cavitary lesion at L1, and a chronic spinal epidural hematoma extending from L1 to L3. Because of intractable back pain, a percutaneous vertebroplasty was performed. The pain improved dramatically and follow-up magnetic resonance imaging obtained three days after the procedure showed a nearly complete resolution of the hematoma. Here, we present the rare case of a chronic spinal epidural hematoma associated with Kummell's disease and discuss the possible mechanism.

• Journal of Korean Neurosurgical Society
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• v.56 no.6
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• pp.521-526
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• 2014

The authors report a case of symptomatic epidural gas accumulation 2 weeks after the multi-level lumbar surgery, causing postoperative recurrent radiculopathy. The accumulation of epidural gas compressing the dural sac and nerve root was demonstrated by CT and MRI at the distant two levels, L3-4 and L5-S1, where vacuum in disc space was observed preoperatively and both laminectomy and discectomy had been done. However, postoperative air was not identified at L4-5 level where only laminectomy had been done in same surgical field, which suggested the relationship between postoperative epidural gas and the manipulation of disc structure. Conservative treatment and needle aspiration was performed, but not effective to relieve patient's symptoms. The patient underwent revision surgery to remove the gaseous cyst. Her leg pain was improved after the second operation.

• The Korean Journal of Pain
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• v.14 no.2
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• pp.245-248
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• 2001

Lysis of epidural adhesion has been done in patients with refractory lumbar radiculopathies. Cauda equina syndrome is a rare complication of epidural block. We report on a case of cauda equina syndrome following epidural adhesiolysis in a patient with spinal stenosis. The patient complained of numbness of the perineum, weakness of the left leg, an inability to void and fecal incontinence. She was treated with medication, bladder training and physical therapy, and finally recovered 1 month after the procedure without any sequelae. We suggest that the causative factors are osmotic damage produced by the subarachnoid injection of large doses of hypertonic saline and temporary neural compression due to spinal stenosis.

• Journal of the Korean Orthopaedic Association
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• v.56 no.2
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• pp.178-182
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• 2021

Spinal hematomas are a rare but serious complication that is typically observed in the epidural space. Spinal subdural hematomas are a dangerous clinical situation because of their potential to cause significant compression of the neural elements and can be mistaken easily for spinal epidural hematomas. This paper reports a case of a severe whole lumbar subdural hematoma after a simple epidural injection that was treated with surgical decompression with excellent clinical results.

• Journal of Korean Neurosurgical Society
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• v.41 no.6
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• pp.377-381
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• 2007

Objective : The aim of this study was to evaluate the morphometric changes in neuroforamen in grade I isthmic spondylolisthesis by anterior lumbar interbody fusion [ALIF]. Methods : Fourteen patients with grade I isthmic spondylolisthesis who underwent single level ALIF with percutaneous pedicle screw fixation were enrolled. All patients underwent standing lateral radiography and magnetic resonance imaging [MRI] before surgery and at 1 week after surgery. For quantitative analysis, the foraminal height, width, epidural foraminal height, epidural foraminal width, and epidural foraminal area were evaluated at the mid-portion of 28 foramens using T2-weighted sagittal MRI. For qualitative analysis, degree of neural compression in mid-portion of 28 foramens was classified into 4 grades using T2-weighted sagittal MRI. Clinical outcomes were assessed using Visual Analogue Sale [VAS] scores for leg pain and Oswestry disability index before surgery and at 1 year after surgery. Results : The affected levels were L4-5 in 10 cases and L5-S1 in 4. The mean foraminal height was increased [p<0.001], and the mean foraminal width was decreased [p=0.014] significantly after surgery. The mean epidural foraminal height [p<0.001], epidural foraminal width [p<0.001], and epidural foraminal area [p<0.001] showed a significant increase after surgery. The mean grade for neural compression was decreased significantly after surgery [p<0.001]. VAS scores for leg pain [p=0.001] and Oswestry disability index [p=0.001] was decreased significantly at one year after surgery. Conclusion : Foraminal stenosis in grade I isthmic spondylolisthesis may effectively decompressed by ALIF with percutaneous pedicle screw fixation.

• The Korean Journal of Pain
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• v.26 no.3
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• pp.286-290
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• 2013

Air injected into the epidural space may spread along the nerves of the paravertebral space. Depending on the location of the air, neurologic complications such as multiradicular syndrome, lumbar root compression, and even paraplegia may occur. However, cases of motor weakness caused by air bubbles after caudal epidural injection are rare. A 44-year-old female patient received a caudal epidural injection after an air-acceptance test. Four hours later, she complained of motor weakness in the right lower extremity and numbness of the S1 dermatome. Magnetic resonance imaging showed no anomalies other than an air bubble measuring 13 mm in length and 0.337 ml in volume positioned near the right S1 root. Her symptoms completely regressed within 48 hours.

• Journal of Korean Neurosurgical Society
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• v.62 no.6
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• pp.727-727
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• 2019

• The Korean Journal of Pain
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• v.9 no.1
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• pp.256-259
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• 1996

Epidural adhesiolysis is a convenient and safe method for the management of back pain. However, we experienced a case where a patient developed sensory change to S2 area after epidural adhesiolysis. Male patient, 43 years old, was admitted to our pain clinic for epidural adhesiolysis for back pain. Patient was experiencing pain radiating to left thigh, and sensory change and motor disturbance to the S1 area. Patient's symptoms and signs were much improved on the first day of epidural adhesiolysis. Patient, however, complained of numbness of perineal and S2 areas after the next day of injections. We postulated the cause of this complication was due to: compression of nerve root by the large volume of injectate and hematoma, and the side effect of local anesthetic, hypertonic saline and steroid.

• Journal of Korean Neurosurgical Society
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• v.29 no.11
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• pp.1533-1537
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• 2000

Granulocytic sarcomas are solid tumors resulting from the localized proliferation of myelogenous leukions cells. Epidural involvement of granulocytic sarcoma is very rare in acute myelogenous leukemia(AML). We report a patient with a thoracic epidural granulocytic sarcoma whose presentation with acute paraparesis led to the diagnosis of relapsing of alleged AML. Early recognition of the etiology of the paraparesis and treatment with emergency decompressive, laminectomy, radiation therapy and chemotherapy resulted in an excellent neurological and hematological outcome.