title: Subdural Thoracolumbar Spine Hematoma after Spinal Anesthesia: A Rare Occurrence and Literature Review of Spinal Hematomas after Spinal Anesthesia.
abstract: Spinal hematomas are a rare but serious complication of spinal epidural anesthesia and are typically seen in the epidural space; however, they have been documented in the subdural space. Spinal subdural hematomas likely exist within a traumatically induced space within the dural border cell layer, rather than an anatomical subdural space. Spinal subdural hematomas present a dangerous clinical situation as they have the potential to cause significant compression of neural elements and can be easily mistaken for spinal epidural hematomas. Ultrasound can be an effective modality to diagnose subdural hematoma when no epidural blood is visualized. We have reviewed the literature and present a full literature review and a case presentation of an 82-year-old male who developed a thoracolumbar spinal subdural hematoma after spinal epidural anesthesia. Anticoagulant therapy is an important predisposing risk factor for spinal epidural hematomas and likely also predispose to spinal subdural hematomas. It is important to consider spinal subdural hematomas in addition to spinal epidural hematomas in patients who develop weakness after spinal epidural anesthesia, especially in patients who have received anticoagulation.
authors.affiliation: Neurosurgery, Seattle Science Foundation.
authors.forename: Prasanthi
authors.initials: P
authors.lastname: Maddali
authors.affiliation: Neurological Surgery, Wayne State University.
authors.forename: Blake
authors.initials: B
authors.lastname: Walker
authors.affiliation: Orthopedic Surgery, Swedish Neuroscience Institute.
authors.forename: Christian
authors.initials: C
authors.lastname: Fisahn
authors.affiliation: Neurosurgery, Swedish Neuroscience Institute.
authors.forename: Jeni
authors.initials: J
authors.lastname: Page
authors.affiliation: Neurological Surgery, Wayne State University.
authors.forename: Vicki
authors.initials: V
authors.lastname: Diaz
authors.affiliation: Anesthesiology and Critical Care, Houston Methodist Hospital.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Zwillman
authors.affiliation: Neurosurgery, Complex Spine, Swedish Neuroscience Institute.
authors.forename: Rod J
authors.initials: RJ
authors.lastname: Oskouian
authors.affiliation: Neurosurgery, Seattle Science Foundation.
authors.forename: R Shane
authors.initials: RS
authors.lastname: Tubbs
authors.affiliation: Seattle Science Foundation.
authors.forename: Marc
authors.initials: M
authors.lastname: Moisi
keywords: spinal anesthesia; spinal epidural anesthesia; spinal epidural hematoma; spinal subdural hematoma