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. 2014 Apr 19:5:55.
doi: 10.4103/2152-7806.131106. eCollection 2014.

Full-endoscopic interlaminar removal of chronic lumbar epidural hematoma after spinal manipulation

Yen-Po Cheng  1 , Kwo-Whei Lee  2 , Ping-Yi Lin  3 , Abel Po-Hao Huang  4 , Chun-Yuan Cheng  1 , Hsin-I Ma  5 , Chien-Min Chen  1 , Dueng-Yuan Hueng  5
Affiliations

Full-endoscopic interlaminar removal of chronic lumbar epidural hematoma after spinal manipulation

Yen-Po Cheng et al. Surg Neurol Int. .

Abstract

Background: Spinal manipulation is widely used for low back pain treatments. Complications associated with spinal manipulation are seen. Lumbar epidural hematoma (EDH) is one of the complications reported in the literature. If lumbar chronic EDH symptoms are present, which are similar to those of a herniated nucleus pulposus, surgery may be considered if medical treatment fails. Percutaneous endoscopic discectomy utilizing an interlaminar approach can be successfully applied to those with herniated nucleus pulposus. We use the same technique to remove the lumbar chronic EDH, which is the first documented report in the related literature.

Methods: We present a case with chronic lumbar EDH associated with spinal manipulation. Neurologic deficits were noted on physical examination. We arranged for a full-endoscopic interlaminar approach to remove the hematoma for the patient with the rigid endoscopy (Vertebris system; Richard Wolf, Knittlingen, Germany).

Results: After surgery, the patient's radiculopathy immediately began to disappear. Magnetic resonance imaging (MRI) follow-up 10 days after the surgery revealed no residual hematoma. No complications were noted during the outpatient department follow up.

Conclusions: Lumbar EDH is a possible complication of spinal manipulation. Patient experiencing rapidly progressive neurologic deficit require early surgical evacuation, while conservative treatment may only be applied to those with mild symptoms. A percutaneous full-endoscopic interlaminar approach may be a viable alternative for the treatment of those with chronic EDH with progressive neurologic deficits.

Keywords: Chronic epidural hematoma; endoscopic; interlaminar; lumbar; spinal manipulation.

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Figures

Figure 1
Figure 1
Sagittal MRI revealed mild bulging disc over L5-S1 level without stenosis
Figure 2
Figure 2
Axial MRI revealed an extradural mass in the left posterolateral spinal canal at the L5-S1 level
Figure 3
Figure 3
Sagittal MRI showed (a) inhomogeneous hyperintensity mass on T1-weighted images, and (b) a high to intermittent intensity mass on T2-weighted images
Figure 4
Figure 4
Plan film revealed interlaminar space over L5-S1 which is the entry point of percutaneous endoscopy
Figure 5
Figure 5
Full endoscopic views: (a) A working channel was inserted after flavum ligament opened. (b) An encapsulated hematoma was found. (c) The hematoma was punctured. (d) Ellman bipolar flexible radiofrequency probe tip is activated over the bleeding points around the hematoma once hematoma is removed
Figure 6
Figure 6
Postoperation follow-up axial T2-weighted MRI revealed no residual hematoma
See this image and copyright information in PMC

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