Ali Youssef, Roux François-Xavier, Meder Jean-François, Pallud Johan
Department of Neurosurgery, Sainte-Anne Hospital, Paris, France.
Asian Spine J. 2012 Jun;6(2):152-5. doi: 10.4184/asj.2012.6.2.152. Epub 2012 May 31.
Spinal epidural hematomas (SEHs) are rare complications following spine surgery, especially for single level lumbar discectomies. The appropriate surgical management for such cases remains to be investigated. We report a case of an extensive spinal epidural hematoma from T11-L5 following a L3-L4 discectomy. The patient underwent a single level L4. A complete evacuation of the SEH resulted in the patient's full recovery. When presenting symptoms limited to the initial surgical site reveal an extensive postoperative SEH, we propose: to tailor the surgical exposure individually based on preoperative findings of the SEH; and to begin the surgical exposure with a limited laminectomy focused on the symptomatic levels that may allow an efficient evacuation of the SEH instead of a systematic extensive laminectomy based on imaging.
脊柱硬膜外血肿(SEHs)是脊柱手术后罕见的并发症,尤其是在单节段腰椎间盘切除术后。此类病例的恰当手术治疗方法仍有待研究。我们报告1例L3-L4椎间盘切除术后发生的从T11至L5的广泛脊柱硬膜外血肿病例。该患者接受了单节段L4手术。SEH完全清除后患者完全康复。当局限于初始手术部位的症状提示存在广泛的术后SEH时,我们建议:根据SEH的术前检查结果个体化调整手术显露范围;以针对有症状节段的有限椎板切除术开始手术显露,这可能有利于有效清除SEH,而不是基于影像学进行系统性广泛椎板切除术。