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

Spinales Subduralhämatom nach lumbaler Dekompressionsoperation: Bericht über 2 Fälle

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Summary

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.

Zusammenfassung

Ein Spinales Subduralhämatom (SSDH) nach Wirbeloperation ist extrem selten. Unserem Wissen nach sind nur drei Fälle in der Literatur beschrieben. Eine unabsichtliche Durchtrennung der Dura wurde mit der SSDH in Zusammenhang gebracht, wobei die dadurch entstehenden Druckänderungen in den duralen Kompartments eine Rolle spielen sollen.

Im vorliegenden Bericht beschreiben wir zwei Fälle mit akutem SSDH, das sich nach einer lumbalen Dekompressionsoperation entwickelte. Bei einem dieser Patienten wurde sofort nach Diagnosestellung des SSDH und Verschlechterung der neurologischen Symptome eine dringliche Ausräumung des Hämatoms via Durchtrennung der Dura vorgenommen. Beim zweiten Patienten wurde das SSDH konservativ behandelt, da keine schweren beziehungsweise progredienten motorischen oder sensorischen Defizite vorlagen.

Zusammenfassend ist eine Ausräumung via Durotomie die Therapie der Wahl für Patienten mit SSDH und neurologischer Verschlechterung. Ein konservatives Vorgehen mag bei ausgesuchten Fällen mit fehlenden motorischen und sensorischen Defiziten indiziert sein.

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References

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Acknowledgments

The authors would like to express their gratitude to Jennifer Shue, MS, for her unequivocal support during writing this manuscript.

Conflicts of interest

The authors Marios G. Lykissas, Alexander Aichmair, Richard J. Herzog, Joshua E. Schroeder, Russel C. Huang, and James Farmer declare that there are no conflicts of interest related to the content of the presented manuscript.

Ethical standards

For the two patients presented in this case report, a waiver of patient informed consent and US Health Insurance Portability and Accountability Act (HIPAA) authorization were sought. Information contained in this case report contains no personal identifiers to ensure patient confidentiality and protections. Under these provisions, the institutional review board (IRB) at our institution provided approval of this case.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Spine and Scoliosis Service, Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, 10021, New York, NY, USA

    Marios G. Lykissas MD, PhD, Alexander Aichmair MD, Joshua E. Schroeder MD, Russel C. Huang MD & James Farmer MD

  2. Department of Radiology and Imaging, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA

    Richard J. Herzog MD

Authors
  1. Marios G. Lykissas MD, PhD
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  2. Alexander Aichmair MD
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  3. Richard J. Herzog MD
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  4. Joshua E. Schroeder MD
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  5. Russel C. Huang MD
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  6. James Farmer MD
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Corresponding author

Correspondence to Marios G. Lykissas MD, PhD.

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Lykissas, M., Aichmair, A., Herzog, R. et al. Spinal subdural hematoma following lumbar decompressive surgery: a report of two cases. Wien Klin Wochenschr 127, 71–74 (2015). https://doi.org/10.1007/s00508-014-0632-3

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  • DOI: https://doi.org/10.1007/s00508-014-0632-3

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