Spinal epidural hematoma after spinal cord stimulator trial lead placement in a patient taking aspirin.

Abstract

Spinal epidural hematoma is a rare, but potentially devastating, consequence of accessing the epidural space for anesthesia or interventional pain procedures. There is no consensus to stop aspirin therapy before interventional chronic pain procedures. A 73-year-old woman with postlaminectomy pain syndrome and lumbar radiculopathy underwent percutaneous spinal cord stimulator lead placement. She had been taking aspirin 81 mg/d for several years. Twenty-four hours later, she developed an epidural hematoma. Prompt recognition and surgical management resulted in no long-term neurological sequelae. The only variable that could have led to our patient's epidural hematoma is aspirin. This is the first reported case of aspirin leading to an epidural hematoma following an interventional chronic pain procedure. Prior to interventional pain procedures, one should contemplate cessation of aspirin therapy because there are, at present, no consensus guidelines to direct such a decision.