Epidural Hematoma in an Elderly Patient With Multiple Comorbidities on Aspirin Following Spinal Cord Stimulator...

Spinal cord stimulators (SCSs) are generally a safe and effective treatment for chronic pain conditions. Spinal epidural hematomas (SEHs) after SCS placement or removal, while rare, can be devastating. Aspirin use is not contraindicated in patients undergoing SCS procedures, but it increases bleeding risk. The American Society of Regional Anesthesia and Pain Medicine (ASRA) states that physicians must weigh the risks and benefits of aspirin use in each patient undergoing high-risk procedures, such as SCS trials. Thus, aspirin use, in conjunction with other risk factors for bleeding, must be recognized and assessed before neuraxial procedures.

An 80-year-old woman who developed an SEH with neurological deficits after an SCS trial. Adding to the increased risk of bleeding due to her comorbidities, the patient did not disclose aspirin use. She therefore went for emergent neurosurgical intervention for the removal of SCS leads and epidural hematoma evacuation. Postoperatively, the patient regained bilateral lower extremity strength but remained with a mild deficit in sensation to light touch.

Aspirin use, in conjunction with other risk factors associated with platelet dysfunction, can put patients at high risk for the development of epidural hematomas after neuraxial procedures, such as SCS trials. Physicians must continue to adhere to the ASRA guidelines.