Epidural hematoma after caudal epidural pulsed radiofrequency stimulation A case report

Rationale: Epidural hematoma is a possible complication after neuraxial procedures. Recently, caudal epidural pulsed radiofrequency (PRF) stimulation was reported as an effective method for controlling several types of chronic pain. Herein, we report on a patient who developed a lumbar epidural hematoma after receiving caudal epidural PRF stimulation. Patient concerns: A 75-year-old woman, who was taking oral warfarin (2 mg/d), received caudal epidural PRF stimulation for symmetrical neuropathic pain in both legs due to chronic idiopathic axonal polyneuropathy. She did not discontinue warfarin use before undergoing the procedure. Three days and 12hours after the procedure, motor weakness suddenly manifested in the right leg (manual muscle testing [MMT] = 2-3). Diagnoses: Lumbar magnetic resonance imaging (MRI) performed 7 days after the PRF procedure showed a spinal epidural hematoma at the L1 to L5 levels, compressing the thecal sac. The international normalized ratio was 6.1 at the time of the MRI. Interventions: Decompressive laminectomy from L1 to L5 with evacuation of the hematoma was performed. Outcomes: Three months postoperatively, the motor weakness in the patient's right leg improved to MMT = 4 to 5. Lessons: This case suggests that clinicians should carefully check if patients are taking an anticoagulant medication and ensure that it is discontinued for an appropriate length of time before a caudal epidural PRF procedure is performed.