Conus hematoma following spinal anesthesia in an unrecognized case of occult spinal dysraphism: Lessons from a rare but preventable iatrogenic injury.
- 1Department of Neurosurgery & Gamma Knife, All India Institute of Medical Sciences & Jai Prakash Narayan Apex Trauma Centre, New Delhi, India.
Abstract
Background
Neurological complications following spinal anesthesia are uncommon. However, intramedullary conus hematomas may occur in patients undergoing epidural and spinal anesthesia with undocumented tethered cords, occult spinal dysraphism (OSD), and/or an abnormally low-lying conus medullaris.Case description
A 28-year-old female developed a progressive left foot drop and urinary retention immediately after spinal anesthesia (i.e., lower-segment cesarean section). She had 2 findings consistent with an underlying dysraphic anomaly: a shaved lumbosacral patch/congenital tuft of hair and a longstanding pes cavus deformity. The magnetic resonance scan demonstrated a Type II split cord malformation with a tethered cord terminating at the L5 level. In addition, the spinal anesthetic caused a focal intramedullary conus hematoma. We elected to treat her nonsurgically, and 3 months later, with physical therapy (i.e., ankle-foot orthosis and bladder training), she progressively improved neurologically.Conclusion
Recognition of OSD/low-lying conus before spinal anesthesia would have avoided causing an intramedullary conus hematoma in this patient.
Related
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BibTeX
@article{sengupta2026conus,
title = {{Conus hematoma following spinal anesthesia in an unrecognized case of occult spinal dysraphism: Lessons from a rare but preventable iatrogenic injury.}},
author = {Amartya Sengupta and Chirag Bansal and Ramesh S Doddamani and Hanok Srithej Rayappa},
journal = {Surgical neurology international},
year = {2026},
month = oct,
doi = {10.25259/sni_811_2026},
url = {https://europepmc.org/article/MED/42974591},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Conus hematoma following spinal anesthesia in an unrecognized case of occult spinal dysraphism: Lessons from a rare but preventable iatrogenic injury.
AU - Amartya Sengupta
AU - Chirag Bansal
AU - Ramesh S Doddamani
AU - Hanok Srithej Rayappa
PY - 2026
DA - 2026/10/30
JO - Surgical neurology international
DO - 10.25259/sni_811_2026
UR - https://europepmc.org/article/MED/42974591
AB - Background Neurological complications following spinal anesthesia are uncommon. However, intramedullary conus hematomas may occur in patients undergoing epidural and spinal anesthesia with undocumented tethered cords, occult spinal dysraphism (OSD), and/or an abnormally low-lying conus medullaris.Case description A 28-year-old female developed a progressive left foot drop and urinary retention immediately after spinal anesthesia (i.e., lower-segment cesarean section). She had 2 findings consistent with an underlying dysraphic anomaly: a shaved lumbosacral patch/congenital tuft of hair and a longstanding pes cavus deformity. The magnetic resonance scan demonstrated a Type II split cord malformation with a tethered cord terminating at the L5 level. In addition, the spinal anesthetic caused a focal intramedullary conus hematoma. We elected to treat her nonsurgically, and 3 months later, with physical therapy (i.e., ankle-foot orthosis and bladder training), she progressively improved neurologically.Conclusion Recognition of OSD/low-lying conus before spinal anesthesia would have avoided causing an intramedullary conus hematoma in this patient.
SN - 2229-5097
SN - 2152-7806
ER -