J Korean Soc Spine Surg.  2019 Sep;26(3):94-99. 10.4184/jkss.2019.26.3.94.

Acute and Delayed Epidural Hematoma After Total Spondylectomy for a Metastatic Spinal Tumor: A Case Report

• Kim JH
• Kim YK

• KMID: 2459758
• DOI: http://doi.org/10.4184/jkss.2019.26.3.94

Abstract

STUDY DESIGN: Case report.
OBJECTIVES
We report a case of recurrent spinal epidural hematoma after total spondylectomy for a metastatic spinal tumor. SUMMARY OF LITERATURE REVIEW: Postoperative epidural hematoma is rare, and no case of delayed epidural hematoma after hematoma removal has been reported.
MATERIALS AND METHODS
A 74-year-old woman experienced a ninth thoracic vertebral (T9) pathologic fracture caused by a metastatic spinal tumor and underwent total spondylectomy. Immediate postoperative epidural hematoma occurred and neurological symptoms appeared. After hematoma removal, the symptom improved. Ten days after surgery, the neurological symptoms worsened again. Spine magnetic resonance imaging showed delayed epidural hematoma. Hematoma removal was done again.
RESULTS
The patient's neurological symptoms improved after delayed hematoma removal.
CONCLUSIONS
Delayed hematoma that cause neurological symptoms may occur after primary hematoma removal. If neurological symptoms recur after hematoma removal, the surgeon should consider the possibility of hematoma recurrence. Before total spondylectomy surgery, preoperative embolization is recommended.

Keyword

Delayed epidural hematoma; Metastatic spinal tumor; Total spondylectomy

MeSH Terms

Aged
Female
Fractures, Spontaneous
Hematoma*
Hematoma, Epidural, Spinal
Humans
Magnetic Resonance Imaging
Recurrence
Spine

Figure

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  Fig. 1. Preoperative magnetic resonance imaging (MRI) scan of the thoracic spine. (A) A T2-weighted sagittal MRI scan shows low signal intensity in the central portion of the T9 body, (B) An enhanced sagittal MRI scan shows well-enhanced findings in the T9 body and adjacent soft tissue. (C) An axial MRI scan shows enhancement in both pedicles.

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  Fig. 2. Positron emission tomography computed tomography shows flude-oxyglucose uptake in the T9 vertebra and right iliac bone.

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  Fig. 4. Immediate postoperative computed tomography scan. In the sagittal view (A) and axial view (B), the red arrow shows epidural hematoma at the T9 level.

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  Fig. 3. Immediate postoperative radiographs. Anteroposterior (A) and lateral (B) radiographs show a stable fixation state.

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  Fig. 5. Histopathologic findings reveal metastatic follicular carcinoma of the thyroid in a T9 vertebral bone biopsy. On thyroglobulin immunostaining (A), the carcinoma demonstrates a diagnostic primary thyroid immu-no-phenotype with strong thyroglobulin expression, especially within col-loid pools. In hematoxylin and eosin staining (B), multiple scattered dark small spots/follicles are present between the normal-sized follicles.

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  Fig. 6. Preoperative magnetic resonance imaging of the delayed spinal epidural hematoma. In the sagittal (A) and axial (B) views, an arrow shows compression of spinal cord in the posterior portion of the T9 body caused by the epidural hematoma.

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