Narrative ReviewsSymptomatic Postoperative Epidural Hematoma in the Lumbar SpineButler, Alexander J. MD*; Donnally, Chester J. III MD†; Goz, Vadim MD†; Basques, Bryce A. MD†; Vaccaro, Alexander R. MD, PhD, MBA†; Schroeder, Gregory D. MD† Author Information *Department of Orthopaedic Surgery, University of Miami Hospital, Miami, FL †Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA No funding was received from the National Institutes of Health (NIH), Wellcome Trust, or Howard Hughes Medical Institute (HHMI). Dr Schroeder has received funds to travel from AOSpine and Medtronic. Dr Vaccaro has consulted or has done independent contracting for DePuy, Medtronic, Stryker Spine, Globus, Stout Medical, Gerson Lehrman Group, Guidepoint Global, Medacorp, Innovative Surgical Design, Orthobullets, Ellipse, and Vertex. He has also served on the scientific advisory board/board of directors/committees for Flagship Surgical, AO Spine, Innovative Surgical Design, and Association of Collaborative Spine Research. Dr Vaccaro has received royalty payments from Medtronic, Stryker Spine, Globus, Aesculap, Thieme, Jaypee, Elsevier, and Taylor Francis/Hodder and Stoughton. He has stock/stock option ownership interests in Replication Medica, Globus, Paradigm Spine, Stout Medical, Progressive Spinal Technologies, Advanced Spinal Intellectual Properties, Spine Medica, Computational Biodynamics, Spinology, In Vivo, Flagship Surgical, Cytonics, Bonovo Orthopaedics, Electrocore, Gamma Spine, Location Based Intelligence, FlowPharma, R.S.I., Rothman Institute and Related Properties, Innovative Surgical Design, and Avaz Surgical. He has also served as deputy editor/editor of Spine. In addition, Dr Vaccaro has also provided expert testimony. He has also served as deputy editor/editor of Clinical Spine Surgery. The remaining authors declare no conflict of interest. Reprints: Alexander J. Butler, MD, Department of Orthopaedic Surgery, University of Miami, 1500 NW 12th Avenue, Suite 1021, Miami, FL 33136 (e-mail: [email protected]). Clinical Spine Surgery: November 2022 - Volume 35 - Issue 9 - p 354-362 doi: 10.1097/BSD.0000000000001278 Buy Metrics Abstract A symptomatic postoperative epidural hematoma (SPEH) in the lumbar spine is a complication with variable presentation and the potential to rapidly cause an irrecoverable neurological injury. Significant heterogeneity exists among current case series reporting SPEH in the literature. This review attempts to clarify the known incidence, risk factors, and management pearls. Currently, literature does not support the efficacy of subfascial drains in reducing the incidence of SPEHs and possibly suggests that medication for thromboembolism prophylaxis may increase risk. Acute back pain and progressing lower extremity motor weakness are the most common presenting symptoms of SPEH. Magnetic resonance imaging is the mainstay of diagnostic imaging necessary to confirm the diagnosis, but if not acutely available, an immediate return to the operative theater for exploration without advanced imaging is justified. Treatment of a SPEH consists of emergent hematoma evacuation as a delay in repeat surgery has a deleterious effect on neurological recovery. Outcomes are poorly defined, though a significant portion of patients will have lasting neurological impairments even when appropriately recognized and managed. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.