Delayed postoperative spinal epidural hematoma causing tetraplegia. Case report.
Masashi Neo1, Takeshi Sakamoto, Shunsuke Fujibayashi
1Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan. neo@kuhp.kyoto-u.ac.jp
Journal of Neurosurgery. Spine
|September 12, 2006
Summary
Delayed spinal epidural hematoma (PSEH) can occur over a week after surgery. Patients should avoid strenuous activity post-operation to prevent this rare complication.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Neurology
Background:
- Spinal epidural hematoma (PSEH) is a rare complication following spinal surgery.
- PSEH typically manifests within days of the procedure.
- Delayed PSEH, occurring more than a week post-surgery, is less common but critical.
Observation:
- A 59-year-old male developed sudden neck/shoulder pain and tetraplegia 9 days after cervical laminoplasty.
- Initial computed tomography on postoperative day 7 showed no abnormalities.
- Symptoms onset coincided with straining to defecate, suggesting a potential trigger.
Findings:
- Magnetic resonance imaging revealed a large epidural hematoma.
- Emergency surgery confirmed arterial bleeding from a split muscle wall as the cause.
- The patient recovered fully after hematoma evacuation and revision surgery.
Implications:
- Highlights the possibility of delayed-onset PSEH, even beyond the first week.
- Emphasizes the need for prompt diagnosis of PSEH in patients with post-operative neurological deficits.
- Recommends patient counseling to avoid strenuous activities after spinal surgery to mitigate risk.