Diagnosis and Spontaneous Resolution of an Epidural Hematoma in a Patient Presenting after Cervical Epidural Steroid Injection

While not a cure for the underlying spinal pathology, cervical epidural steroid injections (CESI) are an important minimally invasive treatment for neck pain with radiculopathy. Although CESIs are considered safe, cervical epidural hematoma (CEH) is a major complication and has previously been reported. Patients, who develop CEH, present with acute neck pain and upper extremity radiculopathy. A prolonged time to treatment may lead to worsened neurological outcome. Diagnostic magnetic resonance imaging and surgical decompression is the mainstay of treatment. This report presents a patient with a history of chronic neck pain and repeat cervical injections, who presented with increased neck pain and upper extremity weakness after undergoing a CESI. Initial radiographic findings were complicated and inconclusive of a definitive epidural hematoma. With conservative management, the patient showed signs of clinical improvement and ultimately had spontaneous resolution of his CEH. Though CEH are frequently rapidly progressing and most often surgically decompressed, some acutely presenting cases may be approached conservatively. Though MRI is an important diagnostic tool for CEH, interpretation of radiographic findings, following a recent CESI, may be challenging due to distortion of the epidural space anatomy. Patients with a history of multiple cervical epidural injections may have an increased risk for the development of CEH. Key words: Cervical epidural steroid injection, cervical epidural hematoma, spontaneous resolution, conservative management, magnetic resonance imaging, complication