Lumbar epidural haematoma after acupuncture: a case report and review of the literature.

BACKGROUND

Acupuncture is widely used for lumbar pain, yet needle-related spinal epidural haematoma (SEH) remains a rarely reported but potentially catastrophic complication. The lumbar segment is often assumed to be a "safe" needling zone, and the true incidence, mechanistic basis and preventive strategy for iatrogenic SEH are poorly defined.

CASE PRESENTATION: An 80-year-old Chinese man developed progressive right lumbosciatalgia 10 days after three sessions of electro-acupuncture and a right L5-S1 paravertebral nerve block. Pre-intervention CT had shown no epidural collection; repeat imaging revealed a 3 cm organised haematoma compressing the thecal sac. Formal WHO-UMC causality assessment rated the event 'Probable' iatrogenic, though competing causality with the nerve block cannot be fully excluded. He underwent urgent L5-S1 laminectomy, clot evacuation and cement-augmented pedicle-screw fixation, with complete neurological recovery at 3 months.

CONCLUSION

This case, together with a systematic review of seven similar reports, establishes a clear clinical pathway: repeated lumbosacral needling-venous wall trauma-organised haematoma-nerve-root compression. Key preventive measures include pre-procedure MRI in high-risk subjects, careful individualization of needle depth and electro-acupuncture parameters based on patient anatomy and clinical context. Advanced age and spinal degeneration are not surgical contraindications; timely decompression restores function even after prolonged compression.