ArticleFrontiers in pain research (Lausanne, Switzerland)2022
Pressure-Volume Relationships in the Spinal Canal and Potential Neurological Complications After Epidural Fluid Injections.
Article in Frontiers in pain research (Lausanne, Switzerland), 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed, 17 citations in OpenAlex.
- Low cerebrospinal fluid pressure predisposes to postoperative epidural hematoma following lumbar decompression: a potentially modifiable physiological risk factor.BMC musculoskeletal disorders · 2026Article
- Cutting-edge treatments in amyotrophic lateral sclerosis: the role of molecular pathogenesis in targeted therapies.Stem cell research & therapy · 2025Review
- Epiduroscopy in spinal stenosis. Description of the procedure and safety measures to reduce complications.Pain management · 2025Observational
- Haemorrhagic retinopathy with subfoveal haemorrhage following endoscopic spine surgery: a case report.International journal of ophthalmology · 2025Article
- Ultrasound-guided caudal epidural injection to treat symptoms of lumbar spinal stenosis: a retrospective study.European journal of translational myology · 2024Article
- Transient Consciousness Disorder During Emergency Cesarean Section in Patients with Labor Analgesia.International medical case reports journal · 2024Article
- Safety evaluation of Tofersen in amyotrophic lateral sclerosis based on the FAERS database.Frontiers in neurologyArticle
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Authors and funding
1 author at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
High-volume fluid injections into the spinal canal may lead to severe neurological complications. But when anatomical or pathological conditions in the spinal canal are unfavorable, even small volume epidural injections can cause dangerously high epidural, subarachnoid, and intracranial pressures or pressure gradients. Data obtained from the scientific literature and direct clinical observation are used to derive a first-order approximation of epidural, subarachnoid, and intracranial pressure responses to epidural fluid injections. Maximum allowable fluid volumes for single or multiple divided fluid injections over time are calculated. In the presence of spinal pathology, 10 ml of fluids may increase epidural pressure to >100 mmHg. Injection speed >4 ml per second may also generate dangerously high intraspinal and intracranial pressures. Intermitted bolus injections provide limited protection, but intraspinal pressures may rise very fast when a critical total injected volume is reached. Potential complications of increased intracranial pressures or large pressure waves include nerve palsies, tinnitus, blindness, stroke, and death. Spinal injections or endoscopy should be performed in an awake responsive patient or with direct cerebrospinal fluid pressure monitoring. A set of guidelines for epidural fluid management is given.
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