Suture-Related Delayed Epidural Hematoma Following Cervical Open-Door Laminoplasty: A Report of Two Cases and
Xiaoxuan Huang1, Can Guo1, Junbo He2,3
1Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.
Background:
Delayed postoperative spinal epidural hematoma (DPSEH) is a rare but serious complication of cervical open-door laminoplasty, which occurs more than 3 days after the procedure. Although multi-level surgery, coagulopathy, and hypertension are known risk factors, suture-related mechanisms have rarely been identified as the main cause.
Case Presentation:
We present two cases of symptomatic DPSEH occurring on the seventh postoperative day following posterior cervical open-door laminoplasty. Following initial recovery, both patients experienced acute neurological deterioration. An emergency MRI revealed hematomas within the paraspinal muscles compressing the spinal cord. Intraoperative exploration identified a huge hematoma within the posterior cervical muscles and active bleeding from muscle tissue, with no injury to the epidural venous plexus. Interestingly, absorbable barbed sutures were used for muscular and fascial closure in both procedures. The patients exhibited significant neurological recovery following emergency hematoma evacuation.
Conclusion:
These cases suggest that suture-related complications, specifically knot loosening, suture migration, or barb-induced tissue cutting, may contribute to intramuscular bleeding and subsequent DPSEH. However, given the limited evidence from a two-case report, this association should be interpreted as a clinical alert rather than definitive proof of causality. Surgeons should maintain a high index of suspicion for DPSEH in patients who experience sudden postoperative pain or neurological decline. They should also consider suture choice as a potentially modifiable risk factor.
