Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2022 Jul;12(7):75-78.
doi: 10.13107/jocr.2022.v12.i07.2924.

Anterior Spinal Surgery Requiring Thoracotomy for Post-Operative Hematoma Removal: Two Case Reports

Tomohito Mukaihata  1 , Yasuhiro Shiga  1 , Kazuhide Inage  1 , Yawara Eguchi  1 , Seiji Ohtori  1 , Sumihisa Orita  1   2
Affiliations
Case Reports

Anterior Spinal Surgery Requiring Thoracotomy for Post-Operative Hematoma Removal: Two Case Reports

Tomohito Mukaihata et al. J Orthop Case Rep. 2022 Jul.

Abstract

Introduction: We report two cases that required revision surgery with thoracotomy for massive hematoma after anterior kyphorectomy surgery.

Case report: A woman with significant thoracolumbar kyphosis due to L1 vertebral fracture showed associated vertebral instability and pain resistant to conservative treatment.She underwent surgery for a one-stage anterior kypholectomy with spinal fusion. We performed an extrapleural approach. On the 4th post-operative day, the patient developed respiratory distress with decreased SpO2. Contrast-enhanced computed tomography (CT) revealed a left hemothorax with active bleeding. Revision surgery was performed to arrest the bleeding, and a large hematoma in the thoracic cavity was observed around the intercostal artery just below the skin incision, not around the surgical site.A man suffered from impaired activities of daily living caused by postural abnormalities due to severe kyphosis from vertebral fractures at the L1 and L2 vertebrae. Thus, we performed two-stage kypholectomy surgery. First, we performed posterior fixation with posterior facet resection. Then, corpectomy of the 1st and 2nd lumbar vertebrae through an anterior extrathoracic approach was performed. A CT scan on the 2nd post-operative day showed a massive hemopneumothorax, indicating persistent bleeding, and we performed a revision surgery to open the chest for additional hemostasis. Intraoperative findings showed a large hematoma, including reactive pleural effusion in the subcutaneous, retroperitoneal, and intrathoracic cavities.

Conclusion: We experienced two patients who required thoracotomy hematoma removal after anterior spinal surgery. Intraoperative patronage and adequate hemostasis are necessary to avoid post-operative complications such as hemothorax and hemopneumothorax.

Keywords: Anterior thoracolumbar kyphorectomy; hematoma; hemothorax; thoracolumbar kyphosis.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: Nil

Figures

Figure 1
Figure 1
Anteroposterior (a) and lateral (b) lumbar X-rays performed after spine surgery. L1 corpectomy, mesh cage (autologous bone filling) fixation of L1, and interbody fixation of L2/3 followed by anterior plate fixation from the T12 to L3 vertebra.
Figure 2
Figure 2
Contrast-enhanced CT scan performed on the 4th post-operative day. Left hemothorax with active bleeding.
Figure 3
Figure 3
Anteroposterior (a) and lateral (b) lumbar X-rays. Posterior fixation from T8 to S2-alar-iliac with T12-L3 posterior facet resection along with bone grafting using autogenous bone, allogeneic bone, and artificial bone. Corpectomy of the 1st and 2nd lumbar vertebrae through an anterior extrathoracic approach and fixation with a mesh cage.
Figure 4
Figure 4
CT scan on the 2nd post-operative day showed a massive hemopneumothorax indicating persistent bleeding.
See this image and copyright information in PMC

References

    1. Ikard RW. Methods and complications of anterior exposure of the thoracic and lumbar spine. Arch Surg. 2006;141:1025–34. - PubMed
    1. Ayhan S, Nelson C, Gok B, Petteys RJ, Wolinsky JP, Witham TF, et al. Transthoracic surgical treatment for centrally located thoracic disc herniations presenting with myelopathy:A 5-year institutional experience. J Spinal Disord Tech. 2010;23:79–88. - PubMed
    1. Quraishi NA, Khurana A, Tsegaye MM, Boszczyk BM, Mehdian SM. Calcified giant thoracic disc herniations:Considerations and treatment strategies. Eur Spine J. 2014;23(1):S76–83. - PMC - PubMed
    1. Burrington JD, Brown C, Wayne ER, Odom J. Anterior approach to the thoracolumbar spine:Technical considerations. Arch Surg. 1976;111:456–63. - PubMed
    1. Coe JD, Arlet V, Donaldson W, Berven S, Hanson DS, Mudiyam R, et al. Complications in spinal fusion for adolescent idiopathic scoliosis in the new millennium A report of the Scoliosis Research Society Morbidity and Mortality Committee. Spine (Phila Pa 1976) 2006;31:345–9. - PubMed

Publication types

LinkOut - more resources