vitamin-k-semiquinone-radical and Low-Back-Pain

A 71-year-old woman on warfarin (2.5 mg daily) developed severe low back pain with reduced touch sensation and weakness of the lower limbs that progressed to complete paralysis within 28 to 30 hours. Imaging revealed bleeding at the D4 through D11 level, however the patient refused emergency laminectomy. No recovery was observed and the patient was discharged to a rehabilitation facility. Only few other cases of hematomyelia linked to anticoagulant therapy have been reported. Early diagnosis, appropriate management and immediate intervention are needed to prevent irreversible neurological sequelae. The elusive clinical features at presentation may cause an important diagnostic delay.

Topics: Aged; Anticoagulants; Antifibrinolytic Agents; Delayed Diagnosis; Female; Humans; Low Back Pain; Paralysis; Plasma; Spinal Cord Vascular Diseases; Vitamin K; Warfarin

We report a case of a chronically anticoagulated 59-yr-old woman who underwent an L4 to L5 epidural block to relieve her low back pain and subsequently developed a T7 to L5 epidural hematoma with cauda equina and conus compression. Fresh frozen plasma and vitamin K were given before surgery, whereas recombinant activated factor VII was administered during surgery to reverse the coagulopathy and to enable the emergent laminectomy and hematoma evacuation. Recombinant activated factor VII administration proved to be a useful adjunct in the emergent surgical management of a thoracolumbar epidural hematoma.

Topics: Analgesia, Epidural; Anticoagulants; Collagen Type VII; Female; Hematoma, Epidural, Cranial; Hemostatics; Humans; Intraoperative Period; Low Back Pain; Magnetic Resonance Imaging; Middle Aged; Plasma; Recombinant Proteins; Vitamin K

Topics: Back Pain; Chondroitin; Glucuronates; Humans; Low Back Pain; Osteoarthritis; Osteoporosis; Prednisolone; Spinal Diseases; Spinal Dysraphism; Tuberculosis; Tuberculosis, Spinal; Vitamin K