Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 6, 2022; 10(22): 7973-7981
Published online Aug 6, 2022. doi: 10.12998/wjcc.v10.i22.7973
Delayed arterial symptomatic epidural hematoma on the 14th day after posterior lumbar interbody fusion: A case report
Shen-Shen Hao, Zhen-Fu Gao, Hong-Ke Li, Shuai Liu, Sheng-Li Dong, Hong-Lei Chen, Zhi-Fang Zhang
Shen-Shen Hao, Zhen-Fu Gao, Hong-Ke Li, Shuai Liu, Sheng-Li Dong, Hong-Lei Chen, Zhi-Fang Zhang, Department of Spine and Bone Oncology, General Hospital of Pingmei Shenma Medical Group, Pingdingshan 467000, Henan Province, China
Author contributions: Hao SS was a major contributor and wrote the first draft of the article; Gao ZF critically reviewed and edited drafts; Dong SL diagnosed the patient; Gao ZF and Li HK treated the patient; Liu S made substantial contributions to the conception and designed of the manuscript; Chen HL and Zhang ZF followed up the patients; All authors read and approved the final manuscript.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sheng-Li Dong, Chief Doctor, Department of Spine and Bone Oncology, General Hospital of Pingmei Shenma Medical Group, No.1 South Yard, Kuanggong Middle Road, Xinhua District, Pingdingshan 467000, Henan Province, China. dong0375@126.com
Received: January 2, 2022
Peer-review started: January 2, 2022
First decision: April 8, 2022
Revised: May 16, 2022
Accepted: June 26, 2022
Article in press: June 26, 2022
Published online: August 6, 2022
Abstract
BACKGROUND

Delayed arterial symptomatic epidural hematoma (SEH) on the 14th day after posterior lumbar interbody fusion (PLIF) is rare but it may lead to severe complications if not identified and treated in a timely manner. After diagnosis of the current case, early surgical removal of the hematoma and strict hemostasis treatment was accomplished. This case report highlights the importance of swift diagnosis and treatment in SEH patients.

CASE SUMMARY

A 41-year-old male patient with a single-segment lumbar disc herniation underwent left-side PLIF. On the 14th post-operative day, the patient complained of lumbar incision pain with sudden onset accompanied by left limb radiation pain and aggravated cauda equina symptoms. Magnetic resonance imaging examination and a puncture blood draw at the incision site confirmed a delayed arterial SEH. Emergency surgical removal of the hematoma and hemostasis was performed. About 70 mL of hematoma was found in the left incision. Continuous bleeding was found in the anterior branch of the transverse process of the 4th lumbar artery in the muscle area about 2 cm below the transverse process of the 4th lumbar vertebra. A blood jet of about 10 cm in height was observed and bipolar electrocoagulation was used to stop the bleeding. Post-operative lumbar incision pain and left lower limb pain were relieved immediately and gradually disappeared. There was no recurrence during the 12-mo follow-up.

CONCLUSION

For delayed arterial SEH on the 14th day after PLIF, preventive measures including pre-, intra- and post-operative prevention should be implemented.

Keywords: Delayed arterial symptomatic epidural hematoma, Treatment methods, Preventive measures, Posterior lumbar interbody fusion, Case report

Core Tip: Posterior lumbar interbody fusion (PLIF) is a standard surgical method for the treatment of lumbar disc herniation. Delayed arterial symptomatic epidural hematoma is an infrequent complication after lumbar spine surgery, occurring with extreme rarity as late as the 14th day after PLIF. Without timely diagnosis and treatment, clinical consequences could be severe. Once the complication had been found in the present case, early surgical hematoma removal and strict hemostasis treatment were required.