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Multilevel Postoperative Cervical Epidural Hematoma: Complete Removal Through Catheter Drainage of the Unexposed Blood Collection
- Source :
- World Neurosurgery. 149:67-72
- Publication Year :
- 2021
- Publisher :
- Elsevier BV, 2021.
-
Abstract
- Background Postoperative spinal epidural hematoma is a rare complication of anterior cervical discectomy and fusion. This condition may rapidly produce severe neurologic deficits, often requiring a prompt surgical decompression. A multilevel extension of the epidural bleeding has been rarely described after anterior cervical procedures. In such cases, the choice of the most suitable surgical approach may be challenging. Herein, we describe an effective surgical decompression of a C2-T1 ventral epidural hematoma following anterior cervical discectomy and fusion at the C5-C6 level. Methods By reopening the previous approach, the C5-C6 intersomatic cage was removed and the surgical field inspected for bleeding. After removal of the spinal epidural hematoma at this level, a lumbar external drainage catheter was inserted into the epidural space to perform multiple irrigations with saline solution until the washing fluid was clear. Results Immediate postoperative cervical computed tomography and magnetic resonance imaging revealed gross total removal of the epidural hematoma and complete decompression of the spinal cord all along the affected tract. Early postoperative neurologic examination revealed mild lower extremity weakness that fully recovered within hours. Conclusions Although rare, multilevel epidural hematoma following anterior cervical decompression represents a serious complication. The revision of the previous anterior cervical approach may be considered the first treatment option, allowing to control the primary bleeding site. Catheter irrigation of the epidural space with saline solution may be a useful technique for removal of unexposed residual blood collection, avoiding the need for posterior laminectomy or other unnecessary bone demolition.
- Subjects :
- Epidural Space
Male
medicine.medical_specialty
Catheters
Decompression
medicine.medical_treatment
Anterior cervical discectomy and fusion
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Lumbar
Epidural hematoma
medicine
Humans
Lumbar Vertebrae
business.industry
Laminectomy
Middle Aged
Decompression, Surgical
Hematoma, Epidural, Spinal
medicine.disease
Spinal cord
Epidural space
Surgery
Catheter
medicine.anatomical_structure
030220 oncology & carcinogenesis
Cervical Vertebrae
Drainage
Neurology (clinical)
business
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 18788750
- Volume :
- 149
- Database :
- OpenAIRE
- Journal :
- World Neurosurgery
- Accession number :
- edsair.doi.dedup.....33c9d121f24fb10b5bc608c7620d3499