An Acute Spinal Intradural Hematoma after an Extraforaminal Wiltse Approach: A Case Report and Review of the Literature

Author:

Raymaekers Vincent1ORCID,Beck Tobias2,Goebel Svenja2,Janssens Femke2,Van den Branden Lien2,Menovsky Tomas3,Plazier Mark24

Affiliation:

1. Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium

2. Faculty of Medicine and Life Science, Hasselt University, Hasselt, Limburg, Belgium

3. Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium

4. Department of Neurosurgery, Jessa Hospital Campus Virga Jesse, Hasselt, Limburg, Belgium

Abstract

AbstractA nontraumatic spontaneous spinal acute subdural hematoma (sSDH) is a rare complication after spinal surgery. Although an sSDH is often associated with anticoagulation therapy, vascular malformations, or lumbar puncture, the pathogenesis of nontraumatic spontaneous sSDH remains unclear. We present the case of an intradural hematoma after an extraforaminal surgery through the Wiltse approach for an extraforaminal disk herniation at L5/S1. This 58-year-old woman experienced hypoesthesia and progressive motor dysfunction in the left leg several hours postoperation. Urgent magnetic resonance imaging revealed an intradural hematoma at the L1/L2 to L2/L3 level in the ventral dural sac proximal to the surgical level. Surgical decompression was performed. There was no evidence of trauma, coagulopathy, or anticoagulation therapy. To our knowledge, this case is the first to report an acute sSDH proximal to the surgery level after an extraforaminal spinal surgery through the Wiltse approach for an extraforaminal disk herniation. It illustrates that attentive postoperative neurologic monitoring, even in the absence of intraoperative irregularities, remains important to diagnose and treat this complication at the early stage.

Publisher

Georg Thieme Verlag KG

Subject

Neurology (clinical),Surgery

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