Recurrent postoperative symptomatic epidural hematoma after thoracic decompression surgery: a case report and literature review

Postoperative symptomatic epidural hematoma (PSEH) is a rare but potentially devastating complication following thoracic decompression surgery, with an incidence of less than 1%. While isolated PSEH has been well documented, recurrent PSEH,particularly in the thoracic spine which represents an exceptionally rare phenomenon with limited literature available to guide clinical management.

This is a case of a 64-year-old male patient who underwent thoracic decompression surgery for ossification of the ligamentum flavum and developed recurrent PSEH requiring two hematoma evacuations. Due to the timely removing the collagenase covering the dural surface and meticulous intraoperative hemostasis, excellent clinical outcomes were achieved in the end.

Recurrent symptomatic epidural hematoma after thoracic decompression is an exceedingly rare but serious complication. Early recognition, prompt surgical intervention, meticulous management of intraspinal venous hemorrhage and identification of underlying risk factors are essential for optimizing neurological outcomes. This case adds to the limited literature on recurrent PSEH and highlights considerations for intraoperative management.