Editor-in-Chief: Kenneth D. Candido, MD

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  1. IPM;2017;19-26 Fish Oil as a Potential Contributor to Epidural Hematoma Following Cervical Epidural Steroid Injection: A Case Report and Focused Literature Review
    Case Report/Literature Review
    Eric J. Jenkie, DO, Ramsin M. Benyamin, MD, and Laxmaiah Manchikanti, MD.

Fish oil has been anecdotally linked to bleeding complications during interventional spinal procedures. We present a case report involving a cervical epidural hematoma following cervical epidural injection in a patient who has been taking fish oil, with detailed literature review.
A 49-year-old woman with a previous history of anterior cervical disc fusion at C5-C6 underwent routine cervical epidural injection for neck pain due to a disc herniation below her fusion. Thirty minutes after the procedure, she experienced numbness and tingling in both arms and developed severe pain between her shoulder blades. She was sent to the emergency room and soon developed a left-sided wrist drop. An emergent cervical magnetic resonance image (MRI) revealed an epidural hematoma at C6-C7. She underwent emergent surgical decompression of the hematoma through multiple laminectomies at C6, C7, and T1. The surgeon noticed excessive blood oozing through the incision site and left two drains in the wound. She recovered without neurological deficit. Upon further investigation, it was discovered that she had been taking high doses of over-the-counter fish oil.
Ingredients in over-the-counter preparations are not regulated or standardized. Fish oil use may predispose a patient to bleeding complications when used in higher doses alone or when used at any dose in conjunction with antiplatelet therapy. The benefits of fish oil use should be weighed against the potential risk of bleeding with cessation of fish oil in patients undergoing spinal interventions. As described by others, significant pain at the site of injection which is unusual and different from the pain experienced in the past as well as complicating factor of loss of resistance technique in closed space must be considered. Finally, rapid diagnosis and intervention avoids neurological deficit.
Key words: Fish oil, omega-3, aspirin, cervical epidural steroid injection, complication, epidural hematoma, literature review