Background:

Postoperative spinal epidural hematoma (SEH) is a rare complication of anterior cervical discectomy and fusion (ACDF). This condition may rapidly produce severe neurological deficits, often requiring a prompt surgical decompression. A multilevel extension of the epidural bleeding has been rarely described after anterior cervical procedures. In such cases, the choice of the most suitable surgical approach may be challenging. Herein, we describe an effective surgical decompression of a C2-T1 ventral epidural hematoma following ACDF at the C5-C6 level.

Methods:

By reopening the previous approach the C5-C6 intersomatic cage was removed and the surgical field inspected for bleeding. After removal of the SEH at this level, a lumbar external drainage catheter was inserted into the epidural space to perform multiple irrigations with saline until the washing fluid was clear.

Results:

Immediate postoperative cervical CT and MRI revealed gross total removal of the epidural hematoma and complete decompression of the spinal cord all along the affected tract. Early postoperative neurological examination revealed mild lower extremity weakness that fully recovered within hours.

Conclusions:

Although rare, multilevel epidural hematoma following anterior cervical decompression represents a serious complication. The revision of the previous anterior cervical approach may be considered the first treatment option, allowing to control the primary bleeding site. Catheter irrigation of the epidural space with saline may be a useful technique for removal of unexposed residual blood collection, avoiding the need for posterior laminectomy or other unnecessary bone demolition.