Delayed spinal extradural hematoma following thoracic spine surgery and resulting in paraplegia: a case report

Postoperative spinal extradural hematomas are rare. Most of the cases that have been reported occured within 3 days of surgery. Their occurrence in a delayed form, that is, more than 72 hours after surgery, is very rare. This case is being reported to enhance awareness of delayed postoperative spina...

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Bibliographic Details
Published in:Journal of medical case reports 2008-05, Vol.2 (1), p.141-141, Article 141
Main Authors: Parthiban, Chandra J K B, Majeed, Shiju A
Format: Article
Language:English
Subjects:
Care and treatment
Case Report
Case studies
Diagnosis
Health aspects
Hematoma
Patient outcomes
Risk factors
Spine
Surgery
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Summary:Postoperative spinal extradural hematomas are rare. Most of the cases that have been reported occured within 3 days of surgery. Their occurrence in a delayed form, that is, more than 72 hours after surgery, is very rare. This case is being reported to enhance awareness of delayed postoperative spinal extradural hematomas. We report a case of acute onset dorsal spinal extradural hematoma from a paraspinal muscular arterial bleed, producing paraplegia 72 hours following surgery for excision of a spinal cord tumor at T8 level. The triggering mechanism was an episode of violent twisting movement by the patient. Fresh blood in the postoperative drain tube provided suspicion of this complication. Emergency evacuation of the clot helped in regaining normal motor and sensory function. The need to avoid straining of the paraspinal muscles in the postoperative period is emphasized. Most cases of postoperative spinal extradural hematomas occur as a result of venous bleeding. However, an arterial source of bleeding from paraspinal muscular branches causing extradural hematoma and subsequent neurological deficit is underreported. Undue straining of paraspinal muscles in the postoperative period after major spinal surgery should be avoided for at least a few days.
ISSN:1752-1947
1752-1947
DOI:10.1186/1752-1947-2-141