PDF(Pubmed)
Abstract：
BACKGROUND: While most complications of cervical surgery are reversible, some, such as symptomatic postoperative spinal epidural hematoma (SEH), which generally occurs within 24 h, are associated with increased morbidity and mortality. Delayed neurological dysfunction is diagnosed in cases when symptoms present > 3 d postoperatively. Owing to its rarity, the risk factors for delayed neurological dysfunction are unclear. Consequently, this condition can result in irreversible neurological deficits and serious consequences. In this paper, we present a case of postoperative SEH that developed three days after hematoma evacuation.
METHODS: A 68-year-old man with an American Spinal Injury Association (ASIA) grade C injury was admitted to our hospital with neck pain and tetraplegia following a fall. The C3-C7 posterior laminectomy and the lateral mass screw fixation surgery were performed on the tenth day. Postoperatively, the patient showed no changes in muscle strength or ASIA grade. The patient experienced neck pain and subcutaneous swelling on the third day postoperatively, his muscle strength decreased, and his ASIA score was grade A. Magnetic resonance imaging showed hypointense signals on T1 weighted image (T1WI) and T2WI located behind the epidural space, with spinal cord compression. Emergency surgical intervention for the hematoma was performed 12 h after onset. Although hypoproteinemia and pleural effusion did not improve in the perioperative period, the patient recovered to ASIA grade C on day 30 after surgery, and was transferred to a functional rehabilitation exercise unit.
CONCLUSIONS: This case shows that amelioration of low blood albumin and pleural effusion is an important aspect of the perioperative management of cervical surgery. Surgery to relieve the pressure on the spinal cord should be performed as soon as possible to decrease neurological disabilities.
METHODS: A 68-year-old man with an American Spinal Injury Association (ASIA) grade C injury was admitted to our hospital with neck pain and tetraplegia following a fall. The C3-C7 posterior laminectomy and the lateral mass screw fixation surgery were performed on the tenth day. Postoperatively, the patient showed no changes in muscle strength or ASIA grade. The patient experienced neck pain and subcutaneous swelling on the third day postoperatively, his muscle strength decreased, and his ASIA score was grade A. Magnetic resonance imaging showed hypointense signals on T1 weighted image (T1WI) and T2WI located behind the epidural space, with spinal cord compression. Emergency surgical intervention for the hematoma was performed 12 h after onset. Although hypoproteinemia and pleural effusion did not improve in the perioperative period, the patient recovered to ASIA grade C on day 30 after surgery, and was transferred to a functional rehabilitation exercise unit.
CONCLUSIONS: This case shows that amelioration of low blood albumin and pleural effusion is an important aspect of the perioperative management of cervical surgery. Surgery to relieve the pressure on the spinal cord should be performed as soon as possible to decrease neurological disabilities.
摘要：
背景：虽然颈椎手术的大多数并发症是可逆的，一些,如有症状的术后脊髓硬膜外血肿（SEH），通常发生在24小时内，与发病率和死亡率增加有关。在术后症状出现>3d的情况下，诊断出延迟的神经功能障碍。由于它的稀有性,迟发性神经功能障碍的危险因素尚不清楚.因此,这种情况会导致不可逆的神经功能缺损和严重的后果。在本文中,我们介绍一例血肿清除术后3天后出现的术后SEH.
方法：一名68岁患有美国脊柱损伤协会（ASIA）C级损伤的男子因跌倒后颈部疼痛和四肢瘫痪入院。在第10天进行C3-C7后路椎板切除术和侧块螺钉固定手术。术后,患者的肌肉力量或ASIA等级无变化.患者在术后第三天出现颈部疼痛和皮下肿胀，他的肌肉力量下降了,他的ASIA评分为A级。磁共振成像显示T1加权图像（T1WI）和T2WI上的低信号位于硬膜外空间后面，脊髓压迫。发病后12小时对血肿进行紧急手术干预。尽管低蛋白血症和胸腔积液在围手术期没有改善，患者在手术后第30天恢复到ASIAC级，并被转移到功能性康复锻炼单位。
结论：本病例表明改善低血白蛋白和胸腔积液是宫颈手术围手术期处理的一个重要方面。应尽快进行减轻脊髓压力的手术，以减少神经系统残疾。
方法：一名68岁患有美国脊柱损伤协会（ASIA）C级损伤的男子因跌倒后颈部疼痛和四肢瘫痪入院。在第10天进行C3-C7后路椎板切除术和侧块螺钉固定手术。术后,患者的肌肉力量或ASIA等级无变化.患者在术后第三天出现颈部疼痛和皮下肿胀，他的肌肉力量下降了,他的ASIA评分为A级。磁共振成像显示T1加权图像（T1WI）和T2WI上的低信号位于硬膜外空间后面，脊髓压迫。发病后12小时对血肿进行紧急手术干预。尽管低蛋白血症和胸腔积液在围手术期没有改善，患者在手术后第30天恢复到ASIAC级，并被转移到功能性康复锻炼单位。
结论：本病例表明改善低血白蛋白和胸腔积液是宫颈手术围手术期处理的一个重要方面。应尽快进行减轻脊髓压力的手术，以减少神经系统残疾。
