A case report.
We describe a technique to drain a thoracic and cervical postoperative epidural hematoma causing paraplegia after anterior cervical discectomy and fusion.
Postoperative compressive spinal epidural hematoma (SEH) is a devastating complication and early diagnosis and treatment is essential. The most commonly accepted treatment is decompression and drainage of hematoma.
A 65-year-old male with a degenerative disc disease located at C4-C5, C5-C6, and C6-C7 levels with disc herniation underwent a standard anterior cervical decompression and fusion at C4-C5-C6-C7. Three hours after the procedure, the patient started complaining of progressive paraplegia and affectation of upper extremity. A magnetic resonance imaging (MRI) revealed a postoperative SEH extending from C3 to T6, causing compression.
To resolve this unusual complication, a new surgery was performed. An anterior approach through the previous one was performed, and a C6 corpectomy was done. The anterior epidural hematoma was drained with an elastic urinary catheter. At the end of the surgery, a tricortical iliac crest autograft was placed between C5-C7 and the plate was placed as previously.
The patient recovered tactile and vibratory senses, as well as motor function in both hands 12 hours after the second procedure. The complete drainage of the hematoma was MRI-verified the first postoperative day.
The patient was discharged from the hospital presenting a complete sensitive recovery and a 3/5 of muscle recovery. At one year, the patient made a full recovery and was able to walk unassisted.
The treatment of choice in SEH is the early decompression as complete as possible, usually with the same approach or at the level of major compression. In rare cases like this, we recommend the use of an elastic catheter to complete hematoma drainage, distant from the surgical wound.
Level of Evidence: N/A
∗Department of Orthopedic Surgery and Traumatology, Spine Unit, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
†Department of Orthopedic Surgery and Traumatology, Hospital Universitario 12 de Octubre, Madrid, Spain
‡Department of Orthopaedic Surgery, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
Address correspondence and reprint requests to Rafael González-Diaz, MD, PhD, Department of Orthopedic Surgery and Traumatology, Spine Unit, Hospital Universitario Fundación Alcorcón, c/Budapest 1, 28922, Alcorcón, Madrid, Spain. E-mail: firstname.lastname@example.org
Received 14 October, 2015
Revised 9 February, 2016
Accepted 16 March, 2016
The manuscript submitted does not contain information about medical device(s)/drug(s).
No funds were received in support of this work.
Relevant financial activities outside the submitted work: board membership, consultancy, expert testimony, payment for lectures, payment for development of educational presentations.