Delayed spinal epidural hematoma after posterior cervical spine surgery: a case report

Spinal epidural hematoma (SEH) is known as a rare but devastating complication of spinal surgery, which may typically lead to severe consequences if not timely intervened. The incidence of delayed spinal epidural hematoma (DSEH) is considerably lower. Various risk factors might be involved in this process, including hypertension, age, high body mass index, use of non-steroidal anti-inflammatories pre-operation, coagulation dysfunction, Rh-positive blood type and five operative levels. In this study, a 72-year-old woman visited our hospital with the symptoms of numbness and pain in both of her hands. Imaging examinations confirmed the clinical diagnosis of cervical canal stenosis at multiple levels. We conducted total laminectomy cervical vertebra for decompression at C3-C6 and a portion of C7 for her. On postoperative day three, the patient complained of sudden neck pain and numbness of the extremities and even developed a substantial neurological deficit with absent motor (grade 1/5) and sensory nerve function in the entire body. Emergency magnetic resonance imaging (MRI) demonstrated an SEH extended from C3 to C6 followed by significant compression of the spinal cord. Then prompt evacuation of hematoma was conducted three hours after the onset of symptoms. Postoperatively, the patient's motor (grade 4/5) and sensory nerve function improved dramatically. After a month of follow-up, she pointed out that there was a slight numbness in her left fingertip and she could walk slowly without other's help. Once the symptoms occurred, it was of great importance to carry out a comprehensive and detailed medical record, physical examinations, imaging examinations, timely and effective bleeding control during the surgery and high-quality postoperative monitoring.