title: Acute Spinal Epidural Hematoma After Acupuncture: Personal Case and Literature Review.
abstract: BACKGROUND
  Spinal acupuncture is a relatively safe and common analgesic treatment, but it may be complicated by serious adverse effects, such as direct spinal cord and nerve root injury, subdural empyema, and epidural abscesses. In this report we compare our case of an extremely uncommon spinal epidural hematoma, which appeared after treatment by acupuncture, with other similar documented cases.
  
  
  METHODS
  This is the case of a 64-year-old man who presented a left hemiparesis associated with paraesthesia. This appeared several hours after acupuncture treatment for left lumbosciatic pain. The cervicothoracic spine magnetic resonance imaging (MRI) scan showed a cervicothoracic spinal epidural hematoma from C2 to T12. The rapid improvement of the patient's neurologic symptoms justified the adoption of a conservative treatment strategy. This gave excellent long-term results.
  
  
  CONCLUSIONS
  Although a post-acupuncture spinal epidural hematoma (paSEH) is very rare, there are only 6 documented cases, it is a possible complication from acupuncture on the back. The use of very thin needles can produce bleeding, probably venous, in the epidural space. In general, this evolves more slowly than other kinds of epidural hematomas. The symptoms are also less severe, warranting less frequent surgical intervention, and in general there is a good outcome. The possibility of hematoma makes acupuncture contraindicated in patients who have coagulation disorders. The onset of severe spinal pain after spinal or paraspinal acupuncture treatment should lead to the suspicion of a paSEH, and a spinal MRI should be carried out.
authors.affiliation: Department of Neurology and Psychiatry, Neurosurgery, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Domenicucci
authors.affiliation: Department of Neurology "Lancisi,", Neurosurgery, A.O. "San Camillo", Rome, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Marruzzo
authors.affiliation: NESMOS Department, Neurosurgery, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy. Electronic address: ale_pesce83@yahoo.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pesce
authors.affiliation: NESMOS Department, Neurosurgery, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Raco
authors.affiliation: Department of Neurology and Psychiatry, Neurosurgery, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Missori
mesh_terms: D015667:Acupuncture Analgesia / Q000009:adverse effects*; D000208:Acute Disease; D002574:Cervical Vertebrae; D046748:Hematoma, Epidural, Spinal / Q000209:etiology*; D006801:Humans; D017116:Low Back Pain / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012585:Sciatica / Q000628:therapy; D013904:Thoracic Vertebrae
keywords: Acupuncture; Back pain; MRI; Peridural venous plexus; Spinal epidural hematoma