Management of a suspected spinal-epidural hematoma

Spinal-epidural hematoma is a very rare but possibly devastating complication of neuroaxial anesthetic techniques. Traumatic or difficult insertion and the use of concomitant anticoagulation have been well established as risk factors for the development of this complication. The most common signs and symptoms include back pain usually localized at the level of the hematoma, as well as varying degrees of motor and sensory deficits, which are the result of spinal cord or cauda equina compression. If the development of spinal epidural hematoma is suspected, the diagnosis should be confirmed by an emergency MRI. The treatment of choice is emergency surgical decompression. The two strongest prognostic factors are the severity of presenting deficits and the time from onset of symptoms to surgical decompression. Patients who have mild deficits and early surgical decompression have the best prognosis, particularly if surgery is performed within 12 hours of the onset of symptoms.