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Letter to the Editor

Int J Pain 2023; 14(1): 33-34

Published online June 30, 2023 https://doi.org/10.56718/ijp.23-004

Copyright © The Korean Association for the Study of Pain.

Comments on “Intradural Extramedullary Hematoma after Cervical Epidural Injection: A Case Report” by Oh et al.

Sang-Hyuk Park

Yonsei Goodwalk Neurosurgery Clinic, Anyang, Korea

Correspondence to:Sang Hyuk Park, Yonsei Goodwalk Neurosurgery Clinic, 206 Simin-daero, Dongan-gu, Anyang 14072, Korea. Tel: +82-31-387-7585, Fax: +82-31-387-7586, E-mail: carespine@naver.com

Received: April 21, 2023; Accepted: May 27, 2023

Dear Editor:

I read an interesting recently published article, “Intradural Extramedullary Hematoma After Cervical Epidural Injection: A Case Report” by Oh et al. [1]. Because intradural extramedullary hematoma is a complication that rarely occurs after a cervical interlaminar epidural steroid injection, it is a very meaningful report in the field of pain medicine. However, there is one issue in this article.

Oh et al. performed a cervical interlaminar epidural steroid injection, and for the procedure, the needle tip was approached through the posterior interlaminar and finally located in the posterior epidural space. Therefore, theoretically, the hematoma caused by cervical interlaminar epidural steroid injection can develop in the posterior epidural space. Previous studies reported hematoma in the posterior epidural space after cervical interlaminar epidural steroid injection [2-4]. However, the study by Oh et al. reported the occurrence of intradural extramedullary hematoma, especially at the anterior to the spinal cord. Therefore, I believe that it is not definite that the intradural extramedullary hematoma occurred due to the procedure of Oh et al.; Oh et al. should clarify the mechanism of why this unusual adverse event occurred.

No potential conflict of interest relevant to this article was reported.

  1. Oh Y, Lee JY, Sim WS, Kim I, Choi JW: Intradural extramedullary hematoma after cervical epidural injection: a case report. International Journal of Pain 2022; 13: 84-9.
    CrossRef
  2. Banik RK, Chen Chen CC: Spinal epidural hematoma after interlaminar cervical epidural steroid injection. Anesthesiology 2019; 131: 1342-3.
    Pubmed CrossRef
  3. Beasley D, Goree JH: Cervical epidural hematoma following interlaminar epidural steroid injection via the contralateral oblique view in patient taking omega-3 fatty acids. Reg Anesth Pain Med 2019; 44: 253-5.
    Pubmed CrossRef
  4. Benyamin RM, Vallejo R, Wang V, Kumar N, Cedeño DL, Tamrazi A: Acute epidural hematoma formation in cervical spine after interlaminar epidural steroid injection despite discontinuation of clopidogrel. Reg Anesth Pain Med 2016; 41: 398-401.
    Pubmed CrossRef

Article

Letter to the Editor

Int J Pain 2023; 14(1): 33-34

Published online June 30, 2023 https://doi.org/10.56718/ijp.23-004

Copyright © The Korean Association for the Study of Pain.

Comments on “Intradural Extramedullary Hematoma after Cervical Epidural Injection: A Case Report” by Oh et al.

Sang-Hyuk Park

Yonsei Goodwalk Neurosurgery Clinic, Anyang, Korea

Correspondence to:Sang Hyuk Park, Yonsei Goodwalk Neurosurgery Clinic, 206 Simin-daero, Dongan-gu, Anyang 14072, Korea. Tel: +82-31-387-7585, Fax: +82-31-387-7586, E-mail: carespine@naver.com

Received: April 21, 2023; Accepted: May 27, 2023

Body

Dear Editor:

I read an interesting recently published article, “Intradural Extramedullary Hematoma After Cervical Epidural Injection: A Case Report” by Oh et al. [1]. Because intradural extramedullary hematoma is a complication that rarely occurs after a cervical interlaminar epidural steroid injection, it is a very meaningful report in the field of pain medicine. However, there is one issue in this article.

Oh et al. performed a cervical interlaminar epidural steroid injection, and for the procedure, the needle tip was approached through the posterior interlaminar and finally located in the posterior epidural space. Therefore, theoretically, the hematoma caused by cervical interlaminar epidural steroid injection can develop in the posterior epidural space. Previous studies reported hematoma in the posterior epidural space after cervical interlaminar epidural steroid injection [2-4]. However, the study by Oh et al. reported the occurrence of intradural extramedullary hematoma, especially at the anterior to the spinal cord. Therefore, I believe that it is not definite that the intradural extramedullary hematoma occurred due to the procedure of Oh et al.; Oh et al. should clarify the mechanism of why this unusual adverse event occurred.

FUNDING

None.

CONFLICT OF INTEREST

No potential conflict of interest relevant to this article was reported.

References

  1. Oh Y, Lee JY, Sim WS, Kim I, Choi JW: Intradural extramedullary hematoma after cervical epidural injection: a case report. International Journal of Pain 2022; 13: 84-9.
    CrossRef
  2. Banik RK, Chen Chen CC: Spinal epidural hematoma after interlaminar cervical epidural steroid injection. Anesthesiology 2019; 131: 1342-3.
    Pubmed CrossRef
  3. Beasley D, Goree JH: Cervical epidural hematoma following interlaminar epidural steroid injection via the contralateral oblique view in patient taking omega-3 fatty acids. Reg Anesth Pain Med 2019; 44: 253-5.
    Pubmed CrossRef
  4. Benyamin RM, Vallejo R, Wang V, Kumar N, Cedeño DL, Tamrazi A: Acute epidural hematoma formation in cervical spine after interlaminar epidural steroid injection despite discontinuation of clopidogrel. Reg Anesth Pain Med 2016; 41: 398-401.
    Pubmed CrossRef
The Korean Association for the Study of Pain

Vol.14 No.2
December 2023

pISSN 2233-4793
eISSN 2233-4807

Frequency: Semi-Annual

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