Delayed postoperative spinal epidural hematoma after anterior cervical discectomy and fusion: A case report
BackgroundPostoperative spinal epidural hematoma (POSEH) causes rapid neurological deficits within 24 h following the operation and can be fatal. However, some POSEH symptoms manifest three days after the operation, also known as delayed POSEH (DPOSEH). Little attention has been provided upon DPOSEH...
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Frontiers Media S.A.
2022-09-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2022.1005462/full |
| _version_ | 1811204282257506304 |
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| author | Wenbin Xu Wenbin Xu Jiandong Guo Jinjin Zhu Jinjin Zhu Xing Zhao Xing Zhao Iranmanesh Yasaman Jian Chen Jian Chen Jiying Wang Jiying Wang Shunwu Fan Shunwu Fan Xiangqian Fang Xiangqian Fang |
| author_facet | Wenbin Xu Wenbin Xu Jiandong Guo Jinjin Zhu Jinjin Zhu Xing Zhao Xing Zhao Iranmanesh Yasaman Jian Chen Jian Chen Jiying Wang Jiying Wang Shunwu Fan Shunwu Fan Xiangqian Fang Xiangqian Fang |
| author_sort | Wenbin Xu |
| collection | DOAJ |
| description | BackgroundPostoperative spinal epidural hematoma (POSEH) causes rapid neurological deficits within 24 h following the operation and can be fatal. However, some POSEH symptoms manifest three days after the operation, also known as delayed POSEH (DPOSEH). Little attention has been provided upon DPOSEH owing to its rare incidence, resulting in serious consequences upon occurrence. To date, no cases of delayed POSEH after anterior cervical surgery have been reported.Case presentationWe describe a case of DPOSEH that presented with delayed neurological deficits on the fifth day after anterior cervical discectomy and fusion (ACDF) surgery. Methylprednisolone was administered but showed no efficacy. MR revealed low T1 and strip long T2 signals located behind discs. After emergency surgical decompression, the patient's muscle strength returned to the preoperative state. However, his muscle strength decreased again on the seventh postoperative day, and the patient's family refused further surgery. Nine months after ACDF, the patient died of septic shock and respiratory failure.ConclusionsDPOSEH can occur after three days or more following anterior cervical surgery; hence, monitoring of neurological function is suggested to be extended. Complete evaluation of risk factors, timely recognition, and differentiation of neurological symptoms are required for spine surgery. In the case of DPOSEH, methylprednisolone can be administered reasonably during the transition period. However, if there is no resolution of symptoms, emergency surgery should be performed as soon as possible. |
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| last_indexed | 2024-04-12T03:10:20Z |
| publishDate | 2022-09-01 |
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| series | Frontiers in Surgery |
| spelling | doaj.art-e90bda12909845978614f9d5d5eba53d2022-12-22T03:50:23ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2022-09-01910.3389/fsurg.2022.10054621005462Delayed postoperative spinal epidural hematoma after anterior cervical discectomy and fusion: A case reportWenbin Xu0Wenbin Xu1Jiandong Guo2Jinjin Zhu3Jinjin Zhu4Xing Zhao5Xing Zhao6Iranmanesh Yasaman7Jian Chen8Jian Chen9Jiying Wang10Jiying Wang11Shunwu Fan12Shunwu Fan13Xiangqian Fang14Xiangqian Fang15Department of Orthopedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, ChinaKey Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang, Hangzhou, ChinaDepartment of Orthopaedics, Hangzhou Ninth People's Hospital, Hangzhou, ChinaDepartment of Orthopedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, ChinaKey Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang, Hangzhou, ChinaDepartment of Orthopedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, ChinaKey Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang, Hangzhou, ChinaZhejiang University, School of Medicine, Hangzhou, ChinaDepartment of Orthopedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, ChinaKey Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang, Hangzhou, ChinaDepartment of Orthopedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, ChinaKey Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang, Hangzhou, ChinaDepartment of Orthopedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, ChinaKey Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang, Hangzhou, ChinaDepartment of Orthopedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, ChinaKey Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang, Hangzhou, ChinaBackgroundPostoperative spinal epidural hematoma (POSEH) causes rapid neurological deficits within 24 h following the operation and can be fatal. However, some POSEH symptoms manifest three days after the operation, also known as delayed POSEH (DPOSEH). Little attention has been provided upon DPOSEH owing to its rare incidence, resulting in serious consequences upon occurrence. To date, no cases of delayed POSEH after anterior cervical surgery have been reported.Case presentationWe describe a case of DPOSEH that presented with delayed neurological deficits on the fifth day after anterior cervical discectomy and fusion (ACDF) surgery. Methylprednisolone was administered but showed no efficacy. MR revealed low T1 and strip long T2 signals located behind discs. After emergency surgical decompression, the patient's muscle strength returned to the preoperative state. However, his muscle strength decreased again on the seventh postoperative day, and the patient's family refused further surgery. Nine months after ACDF, the patient died of septic shock and respiratory failure.ConclusionsDPOSEH can occur after three days or more following anterior cervical surgery; hence, monitoring of neurological function is suggested to be extended. Complete evaluation of risk factors, timely recognition, and differentiation of neurological symptoms are required for spine surgery. In the case of DPOSEH, methylprednisolone can be administered reasonably during the transition period. However, if there is no resolution of symptoms, emergency surgery should be performed as soon as possible.https://www.frontiersin.org/articles/10.3389/fsurg.2022.1005462/fullanterior cervical discectomy and fusionspinal epidural hematomasurgeryspineanterior cervical discectomy |
| spellingShingle | Wenbin Xu Wenbin Xu Jiandong Guo Jinjin Zhu Jinjin Zhu Xing Zhao Xing Zhao Iranmanesh Yasaman Jian Chen Jian Chen Jiying Wang Jiying Wang Shunwu Fan Shunwu Fan Xiangqian Fang Xiangqian Fang Delayed postoperative spinal epidural hematoma after anterior cervical discectomy and fusion: A case report Frontiers in Surgery anterior cervical discectomy and fusion spinal epidural hematoma surgery spine anterior cervical discectomy |
| title | Delayed postoperative spinal epidural hematoma after anterior cervical discectomy and fusion: A case report |
| title_full | Delayed postoperative spinal epidural hematoma after anterior cervical discectomy and fusion: A case report |
| title_fullStr | Delayed postoperative spinal epidural hematoma after anterior cervical discectomy and fusion: A case report |
| title_full_unstemmed | Delayed postoperative spinal epidural hematoma after anterior cervical discectomy and fusion: A case report |
| title_short | Delayed postoperative spinal epidural hematoma after anterior cervical discectomy and fusion: A case report |
| title_sort | delayed postoperative spinal epidural hematoma after anterior cervical discectomy and fusion a case report |
| topic | anterior cervical discectomy and fusion spinal epidural hematoma surgery spine anterior cervical discectomy |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2022.1005462/full |
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