Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 6, 2024; 12(7): 1356-1364
Published online Mar 6, 2024. doi: 10.12998/wjcc.v12.i7.1356
Delayed neurological dysfunction following posterior laminectomy with lateral mass screw fixation: A case report and review of literature
Rui-Zhong Yan, Chao Chen, Chu-Ran Lin, Yan-Hui Wei, Zhi-Jian Guo, Ya-Kun Li, Quan Zhang, He-Yi Shen, Hao-Lin Sun
Rui-Zhong Yan, Chao Chen, Yan-Hui Wei, Zhi-Jian Guo, Ya-Kun Li, Quan Zhang, He-Yi Shen, Department of Orthopedics, Taiyuan Central Hospital, Taiyuan 030009, Shanxi Province, China
Chu-Ran Lin, Department of Orthopedics, Graduate School Shanxi University of Traditional Chinese Medicine, Taiyuan 030024, Shanxi Province, China
Hao-Lin Sun, Department of Orthopedics, Peking University First Hospital, Beijing 100034, China
Author contributions: Yan RZ and Chen C reviewed the literature and contributed to manuscript drafting; Lin CR, Wei YH, and Guo ZJ analyzed and interpreted the imaging founds; Li YK, Zhang Q, and Shen HY contributed to the manuscript editing; Sun HL was the patient’s surgeon and was responsible for the revision of the manuscript; and all authors have read and approved the final manuscript.
Informed consent statement: Patients and their families have signed informed consent form.
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:
Corresponding author: Hao-Lin Sun, Department of Orthopedics, Peking University First Hospital, No. 8 Xishiku Street, Beijing 100034, China.
Received: December 10, 2023
Peer-review started: December 10, 2023
First decision: December 18, 2023
Revised: December 27, 2023
Accepted: February 2, 2024
Article in press: February 2, 2024
Published online: March 6, 2024
Processing time: 81 Days and 16.6 Hours

While most complications of cervical surgery are reversible, some, such as symptomatic postoperative spinal epidural hematoma (SEH), which generally occurs within 24 h, are associated with increased morbidity and mortality. Delayed neurological dysfunction is diagnosed in cases when symptoms present > 3 d postoperatively. Owing to its rarity, the risk factors for delayed neurological dysfunction are unclear. Consequently, this condition can result in irreversible neurological deficits and serious consequences. In this paper, we present a case of postoperative SEH that developed three days after hematoma evacuation.


A 68-year-old man with an American Spinal Injury Association (ASIA) grade C injury was admitted to our hospital with neck pain and tetraplegia following a fall. The C3-C7 posterior laminectomy and the lateral mass screw fixation surgery were performed on the tenth day. Postoperatively, the patient showed no changes in muscle strength or ASIA grade. The patient experienced neck pain and subcutaneous swelling on the third day postoperatively, his muscle strength decreased, and his ASIA score was grade A. Magnetic resonance imaging showed hypointense signals on T1 weighted image (T1WI) and T2WI located behind the epidural space, with spinal cord compression. Emergency surgical intervention for the hematoma was performed 12 h after onset. Although hypoproteinemia and pleural effusion did not improve in the perioperative period, the patient recovered to ASIA grade C on day 30 after surgery, and was transferred to a functional rehabilitation exercise unit.


This case shows that amelioration of low blood albumin and pleural effusion is an important aspect of the perioperative management of cervical surgery. Surgery to relieve the pressure on the spinal cord should be performed as soon as possible to decrease neurological disabilities.

Keywords: Delayed postoperative spinal epidural hematoma, Complications, Spinal surgery, Hypoproteinemia, Risk factor, Case report

Core Tip: Symptomatic postoperative spinal epidural hematoma (PSEH) is a rare but fatal complication of spinal surgery. Here, we present the case of a patient who underwent cervical laminectomy for cervical spinal cord injury with tetraplegia complicated by PSEH. Hypoproteinemia and pleural effusion can aggravate spinal cord edema and worsen the neurological symptoms. Emergency hematoma evacuation is an effective method to relieve the pressure on the spinal cord. A literature review of similar cases was performed.