Catastrophic thoracolumbar spinal massive hematoma triggered by intraspinal anesthesia puncture

Intraspinal anesthesia is generally considered safe, but this case highlights a rare and catastrophic complication: spinal hematoma. The patient experienced significant neurological decline after the procedure, ultimately diagnosed as an intradural hematoma. The primary cause was determined to be the failure to diagnose a pre-existing spinal deformity before administering anesthesia. This oversight led to an improper puncture, causing injury to the spinal cord and subsequent hematoma formation. Despite surgical intervention and rehabilitation, the patient showed limited neurological improvement, underscoring the importance of careful pre-anesthesia evaluation to prevent such complications.

• 1
  The patient presented with a massive spindle-like intradural hematoma compressing the dural sac, extending from T12 to S2.
• 2
  MRI revealed the patient's conus medullaris was located at the L3/4 intervertebral level, and L5 vertebral lamina was absent, indicating congenital spinal bifida and tethered cord syndrome.
• 3
  During surgery, needle-like penetrating points were found on the conus medullaris, indicating direct injury from the anesthesia puncture, and a posterior artery on the surface was pierced.