Spinal epidural hematoma in a scoliotic patient with long fusion: a case report

Abstract

Background context: This is the only reported case on a spinal epidural hematoma occurring in a fused scoliotic segment. Purpose: To report the first case of a spinal epidural hematoma developed within the fused segment of a scoliotic curve and to raise clinicians' awareness of the pathology of a spinal epidural hematoma. Study design/setting: A case report. Patient sample: A 53-year-old woman with long spinal fusion for severe kyphoscoliosis diagnosed as a teenager. Outcome measures: Neurological improvement and clinical follow-up for any occult spinal fracture. Methods: A patient was surgically treated for a spinal epidural hematoma causing paraparesis. Clinical and radiological features were reported. Results: The etiology of this case could not be defined, although the patient had a minor fall injury. Radiography and computed tomography scans could not detect any obvious fracture. Magnetic resonance imaging showed typical features of an epidural hematoma. After the hematoma evacuation, the patient's neurology gradually improved. Conclusions: Long fusion, differential stiffness along the fusion block, implant removal, and significant residual deformity may increase the risk of an epidural hematoma formation after trivial trauma without an obvious fracture on imaging. Clinicians should be mindful of this possibility and look out for any hematoma in the fused segment(s). © 2008 Elsevier Inc. All rights reserved.