Spinal Epidural Hematoma After Percutaneous Kyphoplasty: Case Report and Literature Review

Abstract

Objective

To present the case of a patient on long-term anticoagulants who developed acute spinal epidural hematoma (SEH) after percutaneous kyphoplasty (PKP) without signs of major cement extravasation to the spinal canal.

Methods

A 64-year-old woman with long-term oral antiplatelet drugs underwent the L1 PKP. Immediately after the operation, the back pain improved significantly without neurological deficit. However, 12 hours later, she developed progressive weakness of the bilateral lower limbs. No intraspinal cement leakage was obvious on the postoperative lumbar radiograph and computed tomography.

Results

An emergency MRI examination revealed a high signal aggregation in front of the spinal cord from T12 to L1, indicating spinal cord compression. The SEH was verified and removed during the laminectomy from T12–L1. Following the decompression surgery, the neurological deficit of the lower limbs improved. On follow-up after 6 months, the muscle strength of the bilateral lower limbs had returned to normal.

Conclusion

For the patient with long-term oral antiplatelet drugs or coagulation malfunction, the transpedicle approach or that via the costovertebral joint with a smaller abduction angle is recommended to reduce the risk of injury to the inner wall of the pedicle. For progressive aggravation of neurological dysfunction after surgery, SEH formation should be suspected despite the absence of intraspinal bone cement leakage. Secondary emergency decompression should be considered to avoid permanent damage to spinal cord nerve function caused by continuous compression.

Keywords:

• spinal epidural hematoma
• percutaneous vertebroplasty
• percutaneous kyphoplasty
• spinal cord compression
• coagulation malfunction

Acknowledgments

We thank the National Natural Science Foundation of China (No. 81830077), the Project of China post-doctoral research fund (project no.: 2016M602943XB); Basic scientific research operating expenses (natural science); scientific research project of central university (project no.: XZY012019124); and Shaanxi province post-doctoral research fund enterprise project (project no.: 2017BSHQYXMZZ19) for providing the grant.

Disclosure

The authors report no conflicts of interest for this work.