Thoracic spinal subdural hematoma complicating anterior cervical discectomy and fusion: case report

Abstract

<jats:p>A spinal subdural hematoma is a rare clinical entity with considerable consequences without prompt diagnosis and treatment. Throughout the literature, there are limited accounts of spinal subdural hematoma formation following spinal surgery. This report is the first to describe the formation of a spinal subdural hematoma in the thoracic spine following surgery at the cervical level. A 53-year-old woman developed significant paraparesis several hours after anterior cervical discectomy and fusion of C5–6. Expeditious return to operating room for anterior cervical revision decompression was performed, and the epidural hematoma was evacuated without difficulty. Postoperative imaging demonstrated a subdural hematoma confined to the thoracic level, and the patient was returned to the operating room for a third surgical procedure. Decompression of T1–3, with evacuation of the subdural hematoma was performed. Postprocedure, the patient’s sensory and motor deficits were restored, and, with rehabilitation, the patient gained functional mobility. Spinal subdural hematomas should be considered as a rare but potential complication of cervical discectomy and fusion. With early diagnosis and treatment, favorable outcomes may be achieved.</jats:p>

A systematic review of risk factors and adverse outcomes associated with anterior cervical discectomy and fusion surgery over the past decade

“…We identified three prospective studies,[ 7 20 37 ] 13 retrospective studies,[ 10 27 28 29 32 33 34 35 37 40 65 74 75 ] and four case reports. [ 68 76 77 78 ] The case reports comprised one case of retropharyngeal hematoma 33 h after surgery presented with cervical swelling and dysphagia,[ 68 ] and one case of postoperative cervical hematoma complicated by ipsilateral carotid thrombosis and aphasia after anterior cervical fusion. [ 77 ] A case of cervical wound hematoma 6 weeks after 1-level ACDF was associated with instrument settling resulting in neck pain, dysphagia, and shortness of breath.…”

Posterior longitudinal ligament resection during microscopic anterior cervical discectomy: technique and safety consideration

“…They concluded that the avoidance might be through partial resection and coagulation of the edges. Protzman et al [31] reported that extradural hematoma could complicate ACDF. They attributed it to local trauma at the operative site and hypertension.…”

Anterior cervical surgery for morbidly obese patients should be performed in-hospitals

“…Following ACDF, 2 case studies documented how immediate returns to the operating room without postoperative MR scans failed to correctly diagnose the locations of postoperative hematomas [Table 1]. [7,18] In Hans et al (2003) study, 2.5 hours following a C67 ACDF, the patient developed acute flaccid quadriplegia; they immediately returned to the operating room without a repeat MR to remove a presumed anterior C67 PEH. [7] However, when they failed to find the clot, they then obtained a STAT MR that demonstrated a posterior PEH that warranted an immediate C3-T3 laminectomy.…”

“…In the second case (2016), following a C56 ACDF, the patient developed acute postoperative paraparesis; the immediate return to the operating room without an MR failed to reveal an anterior C56 PEH. [ 18 ] The patient subsequently underwent a STAT cervical/thoracic MR that demonstrated a thoracic subdural hematoma that was acutely treated with a thoracic laminectomy.…”