Conservative Treatment for Spontaneous Resolution of Postoperative Symptomatic Thoracic Spinal Epidural Hematoma-A Case Report

Abstract

Introduction: Postoperative epidural hematomas of the cervical and thoracic spine can pose a great risk of rapid neurological impairment and sometimes require immediate decompressive surgery. Case Report: We present the case of a young patient operated on for stabilization of a two-level thoracic vertebra fracture who developed total paralysis due to an epidural hematoma postoperatively. The course of epidural hematoma was quickly reversed with the help of a conservative technique that prevented revision surgery. The patient regained complete neurologic function very rapidly, and has been well on every follow-up to date. Conclusion: There is a role of similar maneuvers as described in this case to be employed in the management of postoperative epidural hematomas. However, prolonged watchful waiting should still be discouraged, and patients should remain ready for revision surgery if there are no early signs of rapid recovery.

Keywords: fracture; hematoma; spine; thoracic; trauma.

Figure 1

Initial multi-slice computerized tomography scans (midsagittal view) of compression fractures (Th6 A3 type fracture, and an Th12 A1 type fracture, classified according to the AO system).

Figure 2

Intraoperative fluoroscopy images of the two short stabilizations performed; the upper images show the Th5–Th7 fixation that includes the fractured vertebra, and the lower images show the Th11–L1 fixation, the height of the fractured Th12 having been restored using postural reduction on the operating table.

Figure 3

Emergency T2- (A) and T1 (B)-weighted MRI images, midsagittal views of the thoracic spine, show a hyperacute hematoma developing anterior to the spinal cord and spreading cranially to Th4, measuring 7 mm at its thickest. The yellow arrows in both the iamges depict the hematoma that is visible despite interference from implant artifacts.

Figure 4

Emergency T2-weighted MRI image, an axial view at the Th5 level, revealing hyperacute hematoma development anterior to the spinal cord and causing significant dorsal displacement and compression.

Figure 5

Follow-up midsagittal views of T2-weighted (A) and T1-weighted (B) MRI images taken 3 days after the initial emergency MRI showing near complete resolution of the hematoma, measuring 2 mm at its thickest.

Figure 6

Follow-up axial view of an MRI taken 3 days after the initial emergency MRI, showing significant resolution of the hematoma. The view is at the level of Th4.