Percutaneous lumbar epidural adhesiolysis is widely used a treatment for various chronic spinal pain but inadvertent complications of subdural, spinal, or intravascular injection can occur. We report a case of 63-year-old female with unusual pulsatile subdural injection image during attempted lumbar epidural adhesiolysis with fluoroscopy. Pulsatile image confined to the posterior aspect of the spinal canal at L3-4 level was observed. After recognizing subdural injection, we performed epidural adhesiolysis carefully without using steroid and local anesthetics under fluoroscopic guidance. Although unusual, pain physician needed to the understanding of the various subdural fluoroscopic contrast images.

Cranioplasty following decompressive craniectomy is regarded as a relatively simple and safe procedure to protect the brain and improve neurological function. However, some serious complications, such as infection, hematoma, bone resorption, seizure, and epidural or subdural fluid collection may develop after cranioplasty. Among these complications, epidural fluid collection after cranioplasty is not well described and with limited reports on the same. Here, we report recurrent epidural fluid collection after cranioplasty, eventually necessitating the removal of the bone flap. This study discusses the possible pathological mechanisms of this undesirable complication with a review of the literature.

Globally, as well as domestically, patients without risk factors for spontaneous spinal epidural hematoma (SSEH) have rarely been reported. SSEH often results from trauma, epidural catheter insertion for anesthesia and invasive spinal procedures. It could also occur in patients with risk factors such as hypertension, coagulopathy, pregnancy, and vascular anomaly. We encountered a case of a 51-year-old female without prior medical history or any risk factors. Magnetic resonance imaging (MRI) showed subacute SSEH at lumbar spine regions. The patient was treated successfully by surgical decompression. Therefore, we report this case with a review of the relevant literature.

Spontaneous intracranial hypotension (SIH) causes headache in the absence of tissue injury such as trauma, spinal cord injury, surgery, or epidural anesthesia. Epidural blood patch in the epidural space where CSF leakage occurs is effective for treatment of SIH. However, when the leakage site is unknown, administration of autologous blood into the lumbar epidural space could be effective. Here we report on patients who suffered from headache by SIH and could not confirm the leakage site, however, treatment by lumbar epidural blood patch was administered successfully.

Cervical epidural injection is a common treatment for management of neck, shoulder, and upper extremity pain. Although several complications are possible, cardiopulmonary arrest and intraventricular pneumocephalus are rare serious complications, mainly occurring when the dura has been punctured. We report on a case of cardiopulmonary arrest and intraventricular pneumocephalus after cervical epidural injection with loss of resistance technique using air. After performance of cardiopulmonary resuscitation for 30 minutes, a pulse was regained; however, the patient’s mental status was coma. Despite receiving conservative treatment, the patient ultimately died without recovery of consciousness.

After percutaneous endoscopic lumbar discectomy (PELD), postoperative radiating leg pain could persist and become a common problem. This symptom provides important information for use in deciding on performance of reoperation for remnant disc or recurrent disc herniation. Of 225 patients who underwent PELD, 51 patients had persistent radicular pain. Steroid injection to epidural space resulted in pain reduction of at least 50 % in 15 (30.3 %) of these patients. Thirty five cases showed a bad outcome after steroid injection, indicating high sensitivity for detection of a remnant or disc herniation in follow up Magnetic Resonance images (25 cases, 71.4%). Twenty one patients were treated by reoperation. Steroid injection has a diagnostic value with a high sensitivity for mechanical compression of the nerve root as remaining or recurrent disc herniation in MRI for the necessity of a re-operation.

Spinal epidural lipomatosis (SEL) is a rare condition of adipose tissue accumulation in the epidural space. A total of 2,309 subjects from March 2011 to April 2012 were studied. We found different morphologic “variants” of dural sac compression in grade III. The trifid type, resembling the letter “Y", was the most common form. The round type and the localized mass in lateral recess were seen in other cases. Surgical decompression was performed regardless of morphologic variants in SEL grade III with neurologic symptoms. All patients recovered from neurologic symptoms. In subjects who received adequate conservative treatment, decompressive surgery could be helpful in treatment of SEL grade III with neurologic symptoms.