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Case Reports
. 2016 Dec 26;7(Suppl 42):S1089-S1091.
doi: 10.4103/2152-7806.196766. eCollection 2016.

Ultra-delayed lumbar surgical wound hematoma

Merritt D Kinon  1 , Jonathan Nakhla  1 , Kenroy Brown  1 , Niketh Bhashyam  1 , Reza Yassari  1
Affiliations
Case Reports

Ultra-delayed lumbar surgical wound hematoma

Merritt D Kinon et al. Surg Neurol Int. .

Abstract

Background: There exists an inherent risk of increased venous thromboembolism (VTE) in surgical spine patients, which is independent of their existing risk factors. Prophylaxis and treatment of VTE is an imprecise practice and may have serious complications even well after the initial surgery. Furthermore, there are no clear guidelines on how to manage postoperative spine patients with regards to the timing of anticoagulation.

Case description: Here, we present the case of a middle-aged male, status post L2/3 laminectomy and discectomy who developed bilateral below the knee deep venous thrombosis. He was started on Enoxaparin and transitioned to Warfarin and returned with axial back pain, and was found to have a postoperative hematoma almost 3 weeks later in a delayed fashion.

Conclusion: Delayed surgical wound hematoma with neural compression is an important complication to identify and should remain high on the differential diagnosis in patients on warfarin who present with axial spinal pain.

Keywords: Anticoagulation; complication; spinal decompression; venous thromboembolism; wound hematoma.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
(a) Sagittal and (b) axial MRI T2-weighted images showing a large hematoma with severe compression of the thecal sac and spinal nerves. (c) Axial CT scan showing the decompression and a large hypodense collection
See this image and copyright information in PMC

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