Spontaneous resolution of tetraparesis because of postoperative cervical epidural hematoma

Abstract

Background context Symptomatic postoperative spinal epidural hematoma (PSEH) is a rare but potentially devastating postoperative complication, accounting for 0.1% to 0.2% of cases. Purpose To describe a patient with a PSEH that completely resolved, clinically and radiographically, without surgical treatment. Study design Case report and review of the literature. Methods A 47-year-old man with no history of a bleeding disorder underwent anterior cervical interbody fusion for C5–C6 disc herniation. The dura was exposed through removal of the posterior longitudinal ligament, and extensive decompression of posterior osteophytes of C5 and C6 vertebral bodies was performed. The patient developed tetraparesis and respiratory distress rapidly in the postanesthesia care unit and was reintubated for assisted ventilation. The computed tomography (CT) scan revealed a very large ventral epidural hematoma compressing the dural sac from C1 to C6. Results The patient was prepared for hematoma evacuation. However, the neurological symptoms and respiration problems began to resolve spontaneously before the surgery was started. The hematoma was markedly improved on the follow-up CT scan, and the patient was discharged 2 weeks after surgery without neurological deficit. Conclusions This case illustrates that an unpredictable extensive hematoma can occur after uneventful surgery of the cervical spine in low-risk patients. In case of the dural exposure with a creation of hidden and large epidural space, the spine surgeon must pay particular attention to the possibility of a PSEH during the early postoperative period.