Recurrent spinal epidural hematoma: Case report

Negative-pressure dressing management of recurrent postoperative epidural hematoma and uncontrollable intraoperative hemorrhage in posterior spine surgery: report of 4 cases

There is a paucity of literature describing the management of recurrent symptomatic postoperative epidural hematoma or uncontrollable intraoperative hemorrhage in posterior spine surgery. Traditional management with hematoma evacuation and wound closure over suction drains may not be effective in certain cases, and it can lead to recurrence and neurological injury. The authors report 3 cases of recurrent symptomatic postoperative epidural hematoma successfully managed with novel open-wound negative-pressure dressing therapy (NPDT), as well as 1 case of uncontrollable intraoperative hemorrhage that was primarily managed with the same technique. The 3 patients who developed a postoperative epidural hematoma became symptomatic 2-17 days after the initial operation. All 3 patients underwent at least 1 hematoma evacuation and wound closure over suction drains prior to recurrence with severe neurological deficit and definitive management with NPDT. One patient was managed primarily with NPDT for uncontrollable intraoperative hemorrhage during posterior cervical laminectomy. All 4 patients had significant risk factors for postoperative epidural hematoma. NPDT for 3-9 days with delayed wound closure was successful in all patients. The 3 patients with recurrent symptomatic postoperative epidural hematoma had significant improvement in their severe neurological deficit. None of the patients developed a postoperative wound infection, and none of the patients required transfusion due to NPDT. NPDT with delayed wound closure may be an option in certain patients, when wound closure over suction drains is unlikely to prevent further neurological injury.

The classification of recurrent spinal epidural hematoma: a review of the literature and a comparison with the cases

Symptomatic postoperative spinal epidural hematoma (SEH) and spontaneous spinal epidural hematoma (SSEH) are both rare conditions, and recurrent SEH occurs even less frequently. Therefore, we describe a case of symptomatic postoperative SEH after surgical evacuation of SSEH, which was diagnosed using magnetic resonance imaging (MRI) and managed with negative pressure wound therapy (NPWT). The authors classified the reported recurrent SEHs into two types based on the cause of their previous hematoma, which can be classified as spontaneous or postoperative. The characteristics, diagnosis, managements, and results of recurrent SEHs were analyzed. The authors suggest that the postoperative SEH in the Type II will be treated with NPWT, and the new classification will be helpful for prognosis, diagnosis, and management of the recurrent SEHs.

Recurrent Postoperative Spinal Epidural Hematoma in a Patient with Protein S Deficiency

A 71-year-old man underwent cervical laminectomy and developed two symptomatic epidural hematomas during the acute postoperative period. On both occasions, drain obstruction was the predominant cause. Congenital Protein S deficiency was diagnosed postoperatively. Protein S is a vitamin K-dependent natural anticoagulant and is essential for inhibiting thrombosis in microcirculation. We assume that Protein S deficiency followed by perioperative bed-rest and surgical invasiveness led to severe hypercoagulability and subsequent drain obstruction. The present findings suggest that both bleeding disorders and hypercoagulability are risk factors for postoperative symptomatic epidural hematoma.