Neurologic symptoms can occur within hours of spinal surgery. They are usually a sign of an epidural hematoma. A hematoma is a collection or pool of blood contained within a small space. The epidural space is inside the spinal canal between the vertebral bone and the spinal cord.
Hematomas are caused by internal bleeding. The area inside the spinal canal is small enough that any extra fluid puts pressure on the spinal cord or spinal nerves. The result can be severe neurologic problems.
Delayed epidural hematoma after spinal surgery can occur but is very rare. In this report, four cases are reviewed. Similar neurologic symptoms as in an acute case were present days to weeks later.
Risk factors for delayed epidural hematoma may include older age and previous spinal surgery. The use of nonsteroidal antiinflammatory drugs (NSAIDs) can also lead to blood loss during the operation.
Surgeons are advised to be aware that a delayed epidural hematoma after spinal surgery is possible. Severe pain or neurologic signs and symptoms days to weeks later should be evaluated right away. Surgery to take pressure off the neural tissue is important.