• Rafael González-Diaz, Ismael Auñon-Martin, Francisco Javier Ortega-Garcia, and Rui Miguel Reis da Rocha.
• *Department of Orthopedic Surgery and Traumatology, Spine Unit, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain †Department of Orthopedic Surgery and Traumatology, Hospital Universitario 12 de Octubre, Madrid, Spain ‡Department of Orthopaedic Surgery, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
• Spine. 2016 Nov 15; 41 (22): E1368-E1371.

Study DesignA case report.ObjectiveWe describe a technique to drain a thoracic and cervical postoperative epidural hematoma causing paraplegia after anterior cervical discectomy and fusion.Summary Of Background DataPostoperative compressive spinal epidural hematoma (SEH) is a devastating complication and early diagnosis and treatment is essential. The most commonly accepted treatment is decompression and drainage of hematoma.MethodsA 65-year-old male with a degenerative disc disease located at C4-C5, C5-C6, and C6-C7 levels with disc herniation underwent a standard anterior cervical decompression and fusion at C4-C5-C6-C7. Three hours after the procedure, the patient started complaining of progressive paraplegia and affectation of upper extremity. A magnetic resonance imaging (MRI) revealed a postoperative SEH extending from C3 to T6, causing compression.To resolve this unusual complication, a new surgery was performed. An anterior approach through the previous one was performed, and a C6 corpectomy was done. The anterior epidural hematoma was drained with an elastic urinary catheter. At the end of the surgery, a tricortical iliac crest autograft was placed between C5-C7 and the plate was placed as previously.ResultsThe patient recovered tactile and vibratory senses, as well as motor function in both hands 12 hours after the second procedure. The complete drainage of the hematoma was MRI-verified the first postoperative day.The patient was discharged from the hospital presenting a complete sensitive recovery and a 3/5 of muscle recovery. At one year, the patient made a full recovery and was able to walk unassisted.ConclusionThe treatment of choice in SEH is the early decompression as complete as possible, usually with the same approach or at the level of major compression. In rare cases like this, we recommend the use of an elastic catheter to complete hematoma drainage, distant from the surgical wound.Level Of EvidenceN/A.

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