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An Acute Spinal Intradural Hematoma after an Extraforaminal Wiltse Approach: A Case Report and Review of the Literature.
J Neurol Surg A Cent Eur Neurosurg. 2021 Jan; 82(1):100-104.JN

Abstract

A 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.

Authors+Show Affiliations

Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.Faculty of Medicine and Life Science, Hasselt University, Hasselt, Limburg, Belgium.Faculty of Medicine and Life Science, Hasselt University, Hasselt, Limburg, Belgium.Faculty of Medicine and Life Science, Hasselt University, Hasselt, Limburg, Belgium.Faculty of Medicine and Life Science, Hasselt University, Hasselt, Limburg, Belgium.Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium.Faculty of Medicine and Life Science, Hasselt University, Hasselt, Limburg, Belgium. Department of Neurosurgery, Jessa Hospital Campus Virga Jesse, Hasselt, Limburg, Belgium.

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

33086421

Citation

Raymaekers, Vincent, et al. "An Acute Spinal Intradural Hematoma After an Extraforaminal Wiltse Approach: a Case Report and Review of the Literature." Journal of Neurological Surgery. Part A, Central European Neurosurgery, vol. 82, no. 1, 2021, pp. 100-104.
Raymaekers V, Beck T, Goebel S, et al. An Acute Spinal Intradural Hematoma after an Extraforaminal Wiltse Approach: A Case Report and Review of the Literature. J Neurol Surg A Cent Eur Neurosurg. 2021;82(1):100-104.
Raymaekers, V., Beck, T., Goebel, S., Janssens, F., Van den Branden, L., Menovsky, T., & Plazier, M. (2021). An Acute Spinal Intradural Hematoma after an Extraforaminal Wiltse Approach: A Case Report and Review of the Literature. Journal of Neurological Surgery. Part A, Central European Neurosurgery, 82(1), 100-104. https://doi.org/10.1055/s-0040-1714432
Raymaekers V, et al. An Acute Spinal Intradural Hematoma After an Extraforaminal Wiltse Approach: a Case Report and Review of the Literature. J Neurol Surg A Cent Eur Neurosurg. 2021;82(1):100-104. PubMed PMID: 33086421.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - An Acute Spinal Intradural Hematoma after an Extraforaminal Wiltse Approach: A Case Report and Review of the Literature. AU - Raymaekers,Vincent, AU - Beck,Tobias, AU - Goebel,Svenja, AU - Janssens,Femke, AU - Van den Branden,Lien, AU - Menovsky,Tomas, AU - Plazier,Mark, Y1 - 2020/10/21/ PY - 2020/10/22/pubmed PY - 2021/7/10/medline PY - 2020/10/21/entrez SP - 100 EP - 104 JF - Journal of neurological surgery. Part A, Central European neurosurgery JO - J Neurol Surg A Cent Eur Neurosurg VL - 82 IS - 1 N2 - A 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. SN - 2193-6323 UR - https://www.unboundmedicine.com/medline/citation/33086421/An_Acute_Spinal_Intradural_Hematoma_after_an_Extraforaminal_Wiltse_Approach:_A_Case_Report_and_Review_of_the_Literature_ DB - PRIME DP - Unbound Medicine ER -