Symptomatic postoperative spinal epidural hematoma (SEH) is a serious complication of lumbar spine surgery.
Epidural hematomas occur in approximately 0.10%-2,9 % of all spine surgeries 1) 2) 3) 4).
Compressive SEH after spinal surgery is rare, only 41 cases having been reported aside from the series of Deburge et al. In the literature, the frequency is around 1 to 2 for 1000 operations for some authors, as opposed to 3 p. 100 and 6 p. 100 found by two other groups. The 1 p. 100 of the present series is close to the latter values. Nonetheless, it is probably important to take the type of surgery into account, as shown by the current series in which SEH occurred after 5.9 p. 100 of the operations for metastasis, but only once out of 304 anterior cervical interventions. To reduce the risk as much as possible, it is important to be aware of the factors that may contribute to this complication. Once SEH has occurred, the only modifiable prognostic factor appears to be the delay before reintervention 5)
Symptomatic hematoma usually starts with a stabbing pain at the operative site, followed by paresthesia, radicular pain, and neurologic palsy 6).
Several reports of cauda equina syndrome 7) 8) 9) 10) 11).
Symptomatic spinal epidural hematoma usually presents with severe back and leg pain 12) 13).
This uncommon complication may result in devastating neurological sequelae, including lower limb weakness. If they are not quickly identified and treated they can lead to permanent neurological deficits.
Kamoda et al. present a rare case of delayed onset of epidural hematoma after lumbar surgery whose only presenting symptom was vesicorectal disturbance. A 68-year-old man with degenerative spinal stenosis underwent lumbar decompression and instrumented posterolateral spine fusion. The day after his discharge following an unremarkable postoperative course, he presented to the emergency room complaining of difficulty in urination. An MRI revealed an epidural fluid collection causing compression of the thecal sac. The fluid was evacuated, revealing a postoperative hematoma. After removal of the hematoma, his symptoms disappeared immediately, and his urinary function completely recovered. Most reports have characterized postoperative epidural hematoma as occurring early after operation and accompanied with neurological deficits. But it can happen even two weeks after spinal surgery with no pain. Surgeons thus may need to follow up patients for at least a few weeks because some complications, such as epidural hematomas, could take that long to manifest themselves 14).