Nonsurgical segment "spreading-type" symptomatic epidural hematoma formation after lumbar fusion surgery: A case report and literature review.

Although the incidence of epidural hematoma formation after lumbar fusion surgery is low, it is a severe complication. If not managed promptly, it may cause compression of the spinal cord or nerve roots, leading to neurological dysfunctions such as limb numbness, weakness, and abnormal bowel or bladder function. We conducted a comprehensive retrospective review of the medical records, test results, and imaging data of a patient with a rare "spreading-type" symptomatic epidural hematoma occurring in the nonsurgical segment after lumbar fusion surgery. The patient was a 66-year-old male who, due to lumbar disc herniation with spinal stenosis, underwent transforaminal lumbar interbody fusion at L3/4-L4/5 levels under general anesthesia. On the second day after surgery, pain, numbness, weakness, and poor movement of both lower limbs-especially ankles and feet-suddenly appeared. Emergency computed tomography three-dimensional reconstruction of the lumbar spine showed that the implants of the lumbar spine were in good position, and an epidural hematoma was detected in the lumbar operative area. Exploration, hematoma removal, and enlarged decompression of the spinal canal were performed under emergency settings. Postoperative magnetic resonance imaging T2-weighted images revealed hypointensity in the spinal canal between the 12th thoracic and 2nd lumbar vertebra, suggesting the presence of a "spreading-type" epidural hematoma at the nonoperative level. A spreading-type epidural hematoma has been rarely reported in the literature. This type of hematoma mainly spreads longitudinally within the spinal canal and spreads till a distance of more than one vertebral body. A thorough understanding of the occurrence, development, and treatment process of symptomatic epidural hematoma after lumbar spine surgery (especially nonsurgical segment spreading-type hematoma) as well as the implementation of the "prevention-early detection-early surgery" process are crucial for preventing the formation of symptomatic epidural hematoma after spinal surgery and reducing the risk of nerve injury.