Case Reports   |    
Spinal Epidural Hematoma Following Epidural Steroid Injection in a Patient Treated with DabigatranA Case Report
Adam M. Caputo, MD1; Oren N. Gottfried, MD1; Shahid M. Nimjee, MD1; Christopher R. Brown, MD1; Keith W. Michael, MD1; William J. Richardson, MD1
1 Department of Orthopaedic Surgery (A.M.C., C.R.B., K.W.M., W.J.R.), Department of Surgery (O.N.G., S.M.N.), Duke University Medical Center, Box 2807, 335 Baker House, 200 Trent Drive, Durham, NC 27710. E-mail address for A.M. Caputo: adam.caputo@duke.edu
View Disclosures and Other Information
  • Disclosure statement for author(s): PDF

Investigation performed at Duke University Medical Center, Durham, North Carolina

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Case Connector, 2013 Jun 26;3(2):e64 1-4. doi: 10.2106/JBJS.CC.M.00011
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case


Lumbar epidural steroid injections are commonly employed in the treatment of degenerative lumbar conditions. The procedure is generally accepted as safe, and few complications have been reported in the literature. An exceedingly rare complication of epidural steroid injection is a spinal epidural hematoma. Although millions of epidural steroid injections have been completed since 19601-3, to our knowledge, there have been no more than fifteen reported cases of epidural hematoma related to epidural steroid injections4-16. A review of these reports reveals that nearly all of the patients involved were taking anticoagulants near the time of injection. In October 2010, the U.S. Food and Drug Administration (FDA) approved the use of a novel anticoagulant called dabigatran (Pradaxa; Boehringer Ingelheim Pharmaceuticals, Ridgefield, Connecticut) for the prevention of stroke in patients with atrial fibrillation. In Europe and Canada, the drug also has been approved for the prevention of thromboembolism in patients undergoing total joint arthroplasty.
Figures in this Article

    First Page Preview

    View Large
    First page PDF preview
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS Case Connector?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org


    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe

    Related Content
    The Journal of Bone & Joint Surgery
    Provided by:
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    WY - Memorial Hospital of Sweetwater County
    CA - UCLA/OH Department of Orthopaedic Surgery
    PA - Thomas Jefferson University