Iatrogenic Spinal Epidural Hematoma in the Acute Postoperative Period

Spinal epidural hematomas (SEHs) are a rare but serious complication associated with spinal surgery, with an incidence estimated to be as high as 3%. Patients present with back pain and neurologic symptoms, with a typical onset time of several hours to days following surgery.

A 60-year-old female who underwent cervical spine surgery had negative intraoperative neuromonitoring and no apparent neurologic deficits of the upper extremities immediately postsurgery. On arrival in the postanesthesia care unit, the patient reported a loss of sensation in her lower extremities, prompting the anesthesiology resident to perform a focused neurologic examination. The patient demonstrated 0/5 motor strength in the lower extremities and total loss of sensation to touch and temperature up to the level of T10 bilaterally. She was returned to the operating room, and surgical exploration revealed a cervical SEH. Decompression yielded abrupt return of motor evoked potentials and improvement in somatosensory evoked potentials.

As the primary clinician in the perioperative period, the anesthesiologist is ideally positioned to be the first to detect any deterioration in a patient's condition. Anesthesiologists should be cognizant of the potential for acute presentation of SEH so that it can be considered in the differential diagnosis.