1403 - Epidural steroid injection in von Willebrand disease: a case report of safe use with desmopressin

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

CA

Charles Abrams, BS

University of Connecticut School of Medicine - Farmington, CT
Farmington, Connecticut, United States

Co-Author(s)

GH

Gage Hurlburt, DO

Resident physician
University of Connecticut Physical Medicine & Rehabilitation Residency Program
Windsor, Connecticut, United States
DS

Durgadas P. Sakalkale, MD

Associate Professor, Department of Orthopaedic Surgery
UConn Health/UConn School of Medicine, Farmington, CT
Farmington, Connecticut, United States

Submitter(s)

CA

Charles Abrams, BS

University of Connecticut School of Medicine - Farmington, CT
Farmington, Connecticut, United States

Case Diagnosis: Chronic lumbar radiculopathy in a patient with Type 2M von Willebrand Disease (VWD)

Case Description: 55-year-old male with history of VWD presented with chronic low back pain radiating down left anterolateral thigh to his groin. VWD was first diagnosed after recurrent episodes of severe epistaxis and bleeding from minor procedures; subsequent hematologic workup was consistent with Type 2M VWD. Recent coagulation tests were within normal limits. Magnetic Resonance imaging (MRI) of the lumbar spine revealed moderate left L3-L4 and L4-L5 neuroforaminal narrowing. Per recommendation of hematologist, the patient received an infusion of 0.25 mcg/kg desmopressin (DDAVP) completed 30 minutes prior to procedure with 1 liter fluid restriction for 24 hours. He underwent a left transforaminal epidural steroid injection (ESI) at L3-L4. Patient obtained symptomatic relief of groin pain however radicular left thigh pain persisted at 2-week follow-up. Additional left transforaminal ESI at L4-L5 was performed one month later with the same pre-procedure DDAVP protocol. Patient obtained symptomatic pain relief. Both procedures were tolerated without complication.

Discussions: VWD is the most common inherited bleeding disorder with multiple subtypes. Neuraxial techniques such as ESI are approached with caution due to increased risk of bleeding, particularly epidural hematoma. This risk can be mitigated with peri-procedural DDAVP which increases circulating VWF and Factor VIII levels. However, there are no definitive guidelines for neuraxial pain procedures in patients with VWD. In this case, the patient tolerated two transforaminal ESIs with pre-procedural DDAVP and fluid restriction without complication, supporting its role as a safe and practical approach.

Conclusions: Transforaminal epidural steroid injections can be safely performed in patients with VWD using pre-procedural desmopressin and appropriate fluid restriction. This case highlights a potential strategy for mitigating bleeding risk in the absence of established guidelines.