Department of Neurosurgery, Chonnam National University Medical School & Research Institute of Medical Sciences 501-757, Gwangju, Republic of Korea.
Spine J. 2010 Dec;10(12):e1-5. doi: 10.1016/j.spinee.2010.09.021.
Symptomatic postoperative spinal epidural hematoma (PSEH) is a rare but potentially devastating postoperative complication, accounting for 0.1% to 0.2% of cases.
To describe a patient with a PSEH that completely resolved, clinically and radiographically, without surgical treatment.
Case report and review of the literature.
A 47-year-old man with no history of a bleeding disorder underwent anterior cervical interbody fusion for C5-C6 disc herniation. The dura was exposed through removal of the posterior longitudinal ligament, and extensive decompression of posterior osteophytes of C5 and C6 vertebral bodies was performed. The patient developed tetraparesis and respiratory distress rapidly in the postanesthesia care unit and was reintubated for assisted ventilation. The computed tomography (CT) scan revealed a very large ventral epidural hematoma compressing the dural sac from C1 to C6.
The patient was prepared for hematoma evacuation. However, the neurological symptoms and respiration problems began to resolve spontaneously before the surgery was started. The hematoma was markedly improved on the follow-up CT scan, and the patient was discharged 2 weeks after surgery without neurological deficit.
This case illustrates that an unpredictable extensive hematoma can occur after uneventful surgery of the cervical spine in low-risk patients. In case of the dural exposure with a creation of hidden and large epidural space, the spine surgeon must pay particular attention to the possibility of a PSEH during the early postoperative period.
术后脊髓硬膜外血肿（PSEH）是一种罕见但潜在破坏性的术后并发症，占病例的 0.1%至 0.2%。
描述一例 PSEH 患者，其临床表现和影像学均完全缓解，无需手术治疗。
病例报告和文献复习。
一名 47 岁男性，无出血性疾病史，因 C5-C6 椎间盘突出行前路颈椎椎体间融合术。通过切除后纵韧带暴露硬脊膜，并广泛减压 C5 和 C6 椎体的后缘骨赘。患者在麻醉后恢复室迅速出现四肢瘫痪和呼吸困难，并重新插管进行辅助通气。计算机断层扫描（CT）显示一个非常大的腹侧硬膜外血肿，从 C1 到 C6 压迫硬脊膜囊。
患者准备进行血肿清除术。然而，在手术开始前，神经系统症状和呼吸问题开始自发缓解。随访 CT 扫描显示血肿明显改善，患者在术后 2 周出院，无神经功能缺损。
本例说明，在低风险患者中，颈椎手术后即使无并发症，也可能出现不可预测的广泛血肿。在硬脊膜暴露并形成隐蔽而大的硬膜外间隙的情况下，脊柱外科医生必须特别注意在术后早期发生 PSEH 的可能性。
