MRI Spine

Epidural hematoma after neuraxial anesthesia is a rare but a disastrous event. It presents as an acute onset back pain with lower-limb weakness and sensory deficits that occur 2-3 days after initiation or discontinuation of neuraxial anesthesia. Complete or partial paraplegia develops in a few hours. Several risk factors predispose a patient to the development of epidural hematoma including advanced age, needle size, presence of epidural catheter, females, spinal cord and vertebral column abnormalities, presence of underlying coagulopathy, traumatic or difficult needle placement, as well as an indwelling catheter in anticoagulated patient. The American Society of Regional Anesthesia and Pain Medicine has developed updated guidelines specifying timelines of stopping and restarting oral and intravenous anticoagulants which are necessary to avoid this complication. An emergency MRI and decompression within 8 hours is essential for a favorable prognosis.