Acute Spinal Pain During an Attempted Lumbar Epidural Blood Patch in Congenital Lumbar Spinal Stenosis and Epidural Lipomatosis

Abstract

Congenital lumbar spinal stenosis is an uncommon condition that is often asymptomatic in young adults. Herein, we document the first reported occurrence of acute radicular back pain and associated congenital lumbar spinal stenosis in a healthy 24-year-old woman undergoing an epidural blood patch for treatment of a post-dural puncture headache related to an accidental dural puncture sustained during placement of a labor epidural catheter. The acute pain symptoms were elicited twice with injection of less than 1 mL of fluid into the epidural space during the fluoroscopically assisted epidural blood patch. Subsequent magnetic resonance imaging of the lumbar spine demonstrated shortened pedicle length consistent with severe congenital lumbar spinal stenosis and prominent epidural fat. We speculate that the transient increase in pressure within the epidural compartment following injection of a small amount of fluid could have compressed neural structures resulting in severe radicular pain. The prominent epidural fat could have prevented rapid disbursement of the injected fluid which could have further served to propagate the pressure increase throughout the epidural compartment. The unique radiographic features of congenital spinal stenosis could predispose some patients with this unrecognized condition to develop acute pain upon injection of a small amount of fluid into the epidural compartment. Unrecognized congenital lumbar spinal stenosis is an important addition to the differential diagnosis of acute radicular pain elicited during an epidural blood patch in previously asymptomatic patients. Key words: Epidural blood patch, congenital spinal stenosis, epidural lipomatosis, acute spinal pain

Is It Safe to Perform an Autologous Epidural Blood Patch on Patients with Underlying Spinal Stenosis or Lumbar Disc Disease? Case Report and Literature Review

“…In patients who already have compressed nerve roots, this increase in intrathecal pressure can lead to further compression and potential ischemia of the vascular and neural structures of the spinal canal [9]. A prior case report by Hooten et al (2008) documents an instance of a patient with a history of congenital lumbar spinal stenosis developing acute back pain with radicular symptoms after an attempted epidural blood patch for PDPH. In this case, a similar mechanism was postulated for the patient's symptoms [10].…”

“…A prior case report by Hooten et al (2008) documents an instance of a patient with a history of congenital lumbar spinal stenosis developing acute back pain with radicular symptoms after an attempted epidural blood patch for PDPH. In this case, a similar mechanism was postulated for the patient's symptoms [10]. Regardless of the mechanism, patients with underlying spinal stenosis could potentially be at increased risk for further nerve compression with increased epidural pressure [8] [11] [12] [13].…”

Paraplegia Caused by Undiagnosed Metastatic Spinal Tumor in a Patient Receiving Epidural Anaesthesia: A Case Report

“…The pre-existing spinal pathologies may increase the incidence of severe neurological complications, (1,2). Here, we report a patient without obvious symptom of spinal cord or root compression previously who developed paraplegia early following epidural anaesthesia, which was possibly caused by an undiagnosed metastatic spinal tumour.…”

Obesity is a risk factor for epidural lipomatosis: a meta-analysis

“…30 In addition to obesity, other factors may also lead to abnormal fat distribution and cause the occurrence of SEL, such as deformed osteoarthritis, congenital spinal stenosis, and the use of lipase inhibitors, there is insufficient evidence-based evidence. [31][32][33][34][35]…”