Cervical Spinal Epidural Hematoma Following Cervical Posterior Laminoforaminotomy
A 65-year-old man presented with neck pain and right arm pain radiated from shoulder to finger tip 4 weeks ago. Nonoperative supportive treatment including medication, physiotherapy, and injection did not relieve the patient's symptom. The patient could not extend his neck because of severe neck and shoulder pain. On neurologic examination, his right elbow flexion and extension were grade IV- and Spurling sign was elicited on his right arm. MRI showed disc herniation and foraminal stenosis at C5-6 and C6-7 right side (, ). He underwent cervical posterior laminoforaminotomy at C5-6 and C6-7 right side. At operation, there was severe foraminal stenosis, and we confirmed decompression of nerve root successfully. There was no serious bleeding. After operation, he complained persistent right shoulder and arm pain. Repeated MRI showed cervical EDH extending from C5 to T2 right side and spinal cord compression at C5-6-7 due to EDH, also intramuscular and subcutaneous hematoma were seen (, ). He underwent exploration. We extended skin incision more widely and carefully dissected muscle. There was active bleeding at muscular layer and small amount of oozed bleeding at epidural space. Muscular active bleeding was controlled and intramuscular hematoma was removed. Wide laminectomies including further medial facetectomy at C5-6 and C6-7 level were performed. The hematoma in muscular layer and EDH compressing the cervical cord were carefully removed by suction and irrigation. There was minimal oozed epidural bleeding. Meticulous hemostasis was performed, and we assured that there was no another bleeding. We closed operation wound as usual manner with drain insertion. Patient's symptom was improved after hematoma evacuation. After postoperative 6 months, he presented with slight tingling sense of right finger tip.