Spinal subdural hematoma following lumbar decompressive surgery: a report of two cases

Abstract

Spinal subdural hematoma (SSDH) following spine surgery is an extremely rare condition, with only three cases being reported in the literature. Unintended durotomy has been associated with SSDH due to alterations of pressures in the dural compartments. The objective of the present report was to report two rare cases of acute SSDH developed after lumbar decompressive surgery. In one of the patients, the diagnosis of SSDH was followed by urgent hematoma evacuation via durotomy due to the patient's worsening neurological symptoms. In the second patient, the SSDH was treated conservatively due to the absence of severe or progressive motor or sensory deficits. In conclusion, emergency evacuation via durotomy is the treatment of choice for patients with SSDH and neurologic impairment. Conservative management may be indicated in selected cases with absent motor and sensory deficits.

Spinal subdural hematoma after lumbar discectomy without dural injury – Is it possible? A case report and literature review

“…published two cases of acute SSDH after lumbar decompressive surgery, one of whom had an incidental durotomy. [5]…”

Postoperative Spinal Subdural Lesions Following Lumbar Spine Surgery: Prevalence and Risk Factors

“…In contrast, SSDLs, including the arachnoid cyst and subdural hematoma, that develop following spinal surgery are seldom symptomatic and require reoperation. Therefore, there are few reports regarding these pathologies [ 5 10 11 15 16 ].…”

“…SSDH most frequently occurs in patients with coagulopathy after lumbar puncture [ 20 21 ] or with trauma [ 19 22 23 ] and rarely occurs spontaneously in patients receiving anticoagulants or in those who have hematological disorders, vascular malformations, or tumors [ 3 4 7 9 ]. SSDH following spinal surgery is an extremely rare complication, with only five cases having been reported in the literature [ 5 10 11 16 ]. In all cases, lesions became symptomatic within 10 (range, 0–10; mean, 3.8) days of surgery.…”

“…In contrast, spinal subdural hematoma (SSDH) is an extremely rare complication of spinal surgery, with only five cases having been reported in the literature [ 3 4 5 6 7 8 9 ]. Incidental durotomy and traumatic blunt dissection are primary causes of SSDH [ 5 10 11 ]. However, a comprehensive analysis of risk factors for SSDH has not been performed.…”

Symptomatic Postoperative Spinal Subdural Hematoma Following Posterior Lumbar Spinous Process-Splitting Decompression Surgery for Lumbar Spinal Canal Stenosis: A Case Report

“…Our literature review found eight cases of symptomatic acute to subacute PSSH that occurred after posterior lumbar surgery [4][5][6][7][8][9] (Table 1). Unintentional dural tear during surgery was reported to be involved in symptomatic PSSH 4,5) ; however, no intraoperative dural tears were observed in our case.…”