An unusual acute onset hard and small volume epidural blood clotting after anterior cervical discectomy with tetraparetic neurological findings

Year 2021, Volume: 34 Issue: 3, 339 - 343, 27.10.2021

Hadi Sasanı Mehdi Sasanı Fahir Ozer

https://doi.org/10.5472/marumj.1013491

Abstract

Anterior cervical discectomy and fusion (ACDF) is one of the most commonly used surgical method to treat a variety of disorders
in the cervical spine. Although, the incidence of complication related to ACDF is low, hematomas can be confronted after surgery.
We report a 52-year-old male patient presented with complaints of paraesthesia and sensory loss in the upper extremities. Magnetic
resonance imaging (MRI) showed a large central-right paracentral protrusion resulting in narrowing of the spinal channel at the
level of C5-C6 accompanied by spinal cord compression and bilateral foraminal stenosis. ACDF was performed at this level. Five
hours after surgery, sudden onset paraesthesia and tetraparesis developed. Urgent cervical MRI depicted acute filling half of the
discectomy cavity, compressing the dural sac and spinal cord. The patient underwent revision surgery and the symptoms improved
postoperatively. The patient received conservative therapy and was discharged without any nerological problem. Despite being a rare
condition, sudden onset of neurological symptoms such as tetraparesis after ACDF surgery should remind the presence of hematoma
at the surgical site.

Keywords

Discectomy, Magnetic Resonance Imaging, Hematoma

References

• [1] Denaro V, Di Martino A. Cervical spine surgery: an historical perspective. Clin Orthop Relat Res 2011;469:639-48. doi: 10.1007/s11999.010.1752-3.
• [2] Hans P, Delleuze PP, Born JD, Bonhomme V. Epidural hematoma after cervical spine surgery. J Neurosurg Anesthesiol 2003;15:282-5. doi: 10.1097/00008.506.200307000-00020.
• [3] Fowler SB, Anthony-Phillips P, Mehta D, Liebman K. Healthrelated quality of life in patients undergoing anterior cervical discectomy fusion. J Neurosci Nurs 2005;37:97-100.
• [4] Cheung JP, Luk KD. Complications of anterior and posterior cervical spine surgery. Asian Spine J 2016;10:385-400. doi: 10.4184/asj.2016.10.2.385.
• [5] Cabana F, Pointillart V, Vital J, Senegas J. Postoperative compressive spinal epidural hematomas. 15 cases and a review of the literature. Rev Chir Orthop Reparatrice Appar Mot 2000;86:335-45.
• [6] Yi S, Yoon DH, Kim KN, Kim SH, Shin HC. Postoperative Spinal Epidural Hematoma: Risk Factor and Clinical Outcome. Yonsei Med J 2006;47:326-32. doi: 10.3349/ymj.2006.47.3.326.
• [7] Fountas KN, Kapsalaki EZ, Nikolakakos LG, Smisson HF, Johnston KW, Grigorian AA, et al. Anterior cervical discectomy and fusion associated complications. Spine 2007;21:2310-7. doi: 10.1097/BRS.0b013e318154c57e.
• [8] Aono H, Ohwada T, Hosono N, Tobimatsu H, Ariga K, Fuji T, et al. Incidence of postoperative symptomatic epidural hematoma in spinal decompression surgery. J Neurosurg Spine 2011;15:202-5. doi:10.3171/2011.3.SPINE10716.
• [9] Jang JW, Lee JK, Seo BR, Kim SH. Spontaneous resolution of tetraparesis because of postoperative cervical epidural hematoma. Spine J 2010;10:e1-5. doi: 10.1016/j. spinee.2010.09.021.
• [10] Lied B, Sundseth J, Helseth E. Immediate (0–6 h), early (6– 72 h) and late (>72 h) complications after anterior cervical discectomy with fusion for cervical disc degeneration; discharge six hours after operation is feasible. Acta Neurochir 2008;150:111-8. doi: 10.1007/s00701.007.1472-y.
• [11] Suk KS, Kim KT, Lee SH, Park SW. Prevertebral soft tissue swelling after anterior cervical discectomy and fusion with plate fixation. Int Orthop 2006;30:290-4. doi: 10.1007/ s00264.005.0072-9.
• [12] Groen RJ, Ponssen H. The spontaneous spinal epidural hematoma. A study of the etiology. J Neurol Sci 1990;98:121- 38. doi: 10.1016/0022-510x(90)90253-j.
• [13] Groen RJ, van Alphen HA. Operative treatment of spontaneous spinal epidural hematomas: a study of the factor determining postoperative outcome. Neurosurgery 1996;39:494-509. doi: 10.1097/00006.123.199609000-00012.
• [14] Ban D, Liu Y, Cao T, Feng S. Safety of outpatient anterior cervical discectomy and fusion: a systematic review and meta‑analysis. Eur J Med Res 2016;21:34. doi: 10.1186/ s40001.016.0229-6.
• [15] Kim JS, Kuh SU. Immediate Revision Surgery due to Post- Anterior Cervical Discectomy and Fusion (ACDF) Spinal Epidural Hematoma. Korean J Spine 2012;9:111-3. doi: 10.14245/kjs.2012.9.2.111.
• [16] Jankowski R, Zukiel R, Nowak S. Ostry krwiak nadtwardówkowy w odcinku szyjnym kregosłupa—powikłanie po przedniej discektomii C5-C6, C5-C6. Opis przypadku [Acute cervical epidural hematoma as a complication of anterior cervical C5-C6 diskectomy. A case report]. Neurol Neurochir Pol. 2003;37:955-62. In Polish.
• [17] Matsumura A, Namikawa T, Hashimoto R, Okamoto T, Yanagida I, Hoshi M, et al. Clinical management for spontaneous epidural hematoma: diagnosis and treatment. Spine J 2007;8:534-7. doi: 10.1016/j.spinee.2007.01.009.
• [18] Liu Z, Jiao Q, Xu J, Wang X, Li S, You C. Spontaneous spinal epidural hematoma: analysis of 23 cases. Surg Neurol 2008;69:253-60; discussion 260. doi: 10.1016/j. surneu.2007.02.019.
• [19] Lee DY, Lee SH. Cervicothoracic spinal epidural hematoma after anterior cervical spinal surgery. J Korean Neurosurg Soc 2010;48:541-3. doi: 10.3340/jkns.2010.48.6.541.
• [20] Boukobza M, Haddar D, Boissonet M, Merland JJ. Spinal subdural haematoma: a study of three cases. Clin Radiol 2001;56:475-80. doi: 10.1053/crad.2000.0466.
• [21] Qiu W, Sun W, Guo C, Wu Z, Ding M, Shen H. Diagnosis and microsurgery of symptomatic spontaneous spinal epidural hematoma. Ir J Med Sci 2011;180:241-5. doi: 10.1007/ s11845.010.0533-z.
• [22] Adamson T, Godil SS, Mehrlich M, Mendenhall S, Asher AL, McGirt MJ. Anterior cervical discectomy and fusion in the outpatient ambulatory surgery setting compared with the inpatient hospital setting: analysis of 1000 consecutive cases. J Neurosurg Spine 2016;5:1-7. doi: 10.3171/2015.8.SPINE14284.
• [23] Lied B, Rønning PA, Halvorsen CM, Ekseth K, Helseth E. Outpatient anterior cervical discectomy and fusion for cervical disk disease: a prospective consecutive series of 96 patients. Acta Neurol Scand 2013;127:31-7. doi: 10.1111/j.1600- 0404.2012.01674.x.