Thoracic spinal cord epidural hematoma after extracorporeal shock wave lithotripsy

Case report

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Extracorporeal shock wave lithotripsy (ESWL) is a well-established, safe, and effective therapeutic alternative to surgical treatment for urolithiasis. Complications of ESWL do occur in a small number of patients, and when they do, they typically involve the kidney. Formation of a spinal epidural hematoma is an extremely rare complication after ESWL for kidney stone removal. The authors present the case of a 61-year-old man in whom a large spinal epidural hematoma developed after ESWL. They discuss the possible pathogenic mechanism of such a complication.

Abbreviations used in this paper: ESWL = extracorporeal shock wave lithotripsy; SEH = spinal epidural hematoma.

Article Information

Address correspondence to: Kyoung-Suok Cho, M.D., Ph.D., Department of Neurosurgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Uijeongbu 480-130, Korea. email:

Please include this information when citing this paper: published online November 25, 2011; DOI: 10.3171/2011.10.SPINE11236.

© AANS, except where prohibited by US copyright law.



  • View in gallery

    Preoperative sagittal (left) and axial (right) T2-weighted MR images revealing an acute epidural hematoma with maximal compression at the T10–L1 level (arrows).

  • View in gallery

    Postoperative sagittal (left) and axial (right) T2-weighted MR images showing no cord compression.



Braun PKazmi KNogués-Meléndez PMas-Estellés FAparici-Robles F: MRI findings in spinal subdural and epidural hematomas. Eur J Radiol 64:1191252007


Chaussy CSchmiedt EJocham DBrendel WForssmann BWalther V: First clinical experience with extracorporeally induced destruction of kidney stones by shock waves. J Urol 127:4174201982


Cimentepe EEroglu MOztürk UBayrak OTuygun CAcar A: Rapid communication: renal apoptosis after shockwave application in rabbit model. J Endourol 20:109110952006


Donahue LALinke CARowe JM: Renal loss following extracorporeal shock wave lithotripsy. J Urol 142:8098111989


Freund JBColonius TEvan AP: A cumulative shear mechanism for tissue damage initiation in shock-wave lithotripsy. Ultrasound Med Biol 33:149515032007


Geh JLCCurley PMayfield MPPrice JJ: Small bowel perforation after extracorporeal shock wave lithotripsy. Br J Urol 79:6486491997


Hassan IZietlow SP: Acute pancreatitis after extracorporeal shock wave lithotripsy for a renal calculus. Urology 60:11112002


Ilnyckyj AHosking DHPettigrew NMBernstein CN: Extracorporeal shock wave lithotripsy causing colonic injury. Dig Dis Sci 44:248524871999


Kebaish KMAwad JN: Spinal epidural hematoma causing acute cauda equina syndrome. Neurosurg Focus 16:6e12004


Kim TBPark HKLee KYKim KHJung HYoon SJ: Life-threatening complication after extracorporeal shock wave lithotripsy for a renal stone: a hepatic subcapsular hematoma. Korean J Urol 51:2122152010


Kostakopoulos AStavropoulos NJMacrychoritis CDeliveliotis CAntonopoulos KPPicramenos D: Subcapsular hematoma due to ESWL: risk factors. A study of 4,247 patients. Urol Int 55:21241995


Kou JFischgrund JBiddinger AHerkowitz H: Risk factors for spinal epidural hematoma after spinal surgery. Spine (Phila Pa 1976) 27:167016732002


Kreppel DAntoniadis GSeeling W: Spinal hematoma: a literature survey with meta-analysis of 613 patients. Neurosurg Rev 26:1492003


Lazarides MKDrista HArvanitis DPDayantas JN: Aortic aneurysm rupture after extracorporeal shock wave lithotripsy. Surgery 122:1121131997


Lepoire JTridon PMontaut JGermain F: [Spontaneous epidural hematoma.]. Neurochirurgie 7:2983131961. (Fr)


Newman LHSaltzman B: Identifying risk factors in development of clinically significant post-shock-wave lithotripsy subcapsular hematomas. Urology 38:35381991


Shao YConnors BAEvan APWillis LRLifshitz DALingeman JE: Morphological changes induced in the pig kidney by extracorporeal shock wave lithotripsy: nephron injury. Anat Rec A Discov Mol Cell Evol Biol 275:9799892003


Töro KKardos M: Fatal renal hemorrhage after extracorporeal shock wave lithotripsy. J Forensic Sci 53:119111932008


Yi SYoon HKim KNKim SHShin HC: Postoperative spinal epidural hematoma: risk factor and clinical outcome. Yonsei Med J 47:3263322006




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