Case report
Delayed spinal extradural hematoma following thoracic spine surgery and resulting in paraplegia: a case report
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* Corresponding author: Shiju A Majeed shijumajeed@asianetindia.com
Kovai Medical Center and Hospital, Coimbatore, Tamilnadu, India
Journal of Medical Case Reports 2008, 2:141 doi:10.1186/1752-1947-2-141
Published: 2 May 2008Abstract
Introduction
Postoperative spinal extradural hematomas are rare. Most of the cases that have been reported occured within 3 days of surgery. Their occurrence in a delayed form, that is, more than 72 hours after surgery, is very rare. This case is being reported to enhance awareness of delayed postoperative spinal extradural hematomas.
Case presentation
We report a case of acute onset dorsal spinal extradural hematoma from a paraspinal muscular arterial bleed, producing paraplegia 72 hours following surgery for excision of a spinal cord tumor at T8 level. The triggering mechanism was an episode of violent twisting movement by the patient. Fresh blood in the postoperative drain tube provided suspicion of this complication. Emergency evacuation of the clot helped in regaining normal motor and sensory function. The need to avoid straining of the paraspinal muscles in the postoperative period is emphasized.
Conclusion
Most cases of postoperative spinal extradural hematomas occur as a result of venous bleeding. However, an arterial source of bleeding from paraspinal muscular branches causing extradural hematoma and subsequent neurological deficit is underreported. Undue straining of paraspinal muscles in the postoperative period after major spinal surgery should be avoided for at least a few days.