Journal of Pain Research (Nov 2020)
Spinal Epidural Hematoma After Percutaneous Kyphoplasty: Case Report and Literature Review
Abstract
Peng Zou,1,* Han-Lin Gong,2,* Jian-Min Wei,3,* Dong-Mei Wei,4 Li-Xiong Qian,1 Peng Liu,1 Ding-Jun Hao,1 Jun-Song Yang,1 Yuan-Ting Zhao1 1Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China; 2Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, People’s Republic of China; 3Department of Spine Surgery, Baoji City Hospital of Traditional Chinese Medicine, Shaanxi, People’s Republic of China; 4Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu 610041, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yuan-Ting Zhao Tel +86 15229376812Email [email protected] Yang Tel +86 18792883498Email [email protected]: To present the case of a patient on long-term anticoagulants who developed acute spinal epidural hematoma (SEH) after percutaneous kyphoplasty (PKP) without signs of major cement extravasation to the spinal canal.Methods: A 64-year-old woman with long-term oral antiplatelet drugs underwent the L1 PKP. Immediately after the operation, the back pain improved significantly without neurological deficit. However, 12 hours later, she developed progressive weakness of the bilateral lower limbs. No intraspinal cement leakage was obvious on the postoperative lumbar radiograph and computed tomography.Results: An emergency MRI examination revealed a high signal aggregation in front of the spinal cord from T12 to L1, indicating spinal cord compression. The SEH was verified and removed during the laminectomy from T12–L1. Following the decompression surgery, the neurological deficit of the lower limbs improved. On follow-up after 6 months, the muscle strength of the bilateral lower limbs had returned to normal.Conclusion: For the patient with long-term oral antiplatelet drugs or coagulation malfunction, the transpedicle approach or that via the costovertebral joint with a smaller abduction angle is recommended to reduce the risk of injury to the inner wall of the pedicle. For progressive aggravation of neurological dysfunction after surgery, SEH formation should be suspected despite the absence of intraspinal bone cement leakage. Secondary emergency decompression should be considered to avoid permanent damage to spinal cord nerve function caused by continuous compression.Keywords: spinal epidural hematoma, percutaneous vertebroplasty, percutaneous kyphoplasty, spinal cord compression, coagulation malfunction
