颈后路椎管扩大成形术后迟发性颈椎硬膜外血肿合并C5神经根麻痹一例

A case of delayed cervical epidural hematoma with C5 nerve root palsy after posterior cervical laminoplasty

SUMMARY Delayed postoperative spinal epidural hematoma(DPSEH) is a rare and potentially devastating complication of laminoplasty, and cervical nerve root palsy occurs more frequently than DPSEH, especially with C5 nerve root palsy. The authors describe a case of DPSEH with C5 nerve root palsy that developed in a patient 3 days after he underwent laminoplasty. In this case, a 78-year-old man with a history that having taken Aspirin without the doctor’s instruction for 5-6 years,he underwent cervical laminoplasty for mild myelopathy. On the 3rd postoperative day, he complained of weakness of his left upper extremity and could not raise his left arm. The symptom aggravated in the next few days. On the 9th postoperative day, there was an obvious motor deficit of both upper and lower extremities. Magnetic resonance imaging demonstrated abnormal signal characteristics consistent with a hematoma at levels C3-C4, compressing spinal cord. The clot was evacuated during emergency revision surgery, and the postoperative course after the operation was uneventful and the muscle strength was improved five days later. Therefore, the symptoms of DPSEH are not so typical that its possibility should be kept in mind. Sometimes a differential diagnosis should be made with C5 nerve root palsy which may only represent weakness of upper extremities. The authors recommend that magnetic resonance imaging is helpful for the diagnosis of DPSEH and a revision surgery should be taken as soon as possible once the hematoma causing the neurologic deterioration was confirmed.

Delayed postoperative spinal epidural hematoma（DPSEH） is a rare and potentially devastating complication of laminoplasty, and cervical nerve root palsy occurs more frequently than DPSEH, especially with C5 nerve root palsy. The authors describe a case of DPSEH with C5 nerve root palsy that developed in a patient 3 days after he underwent laminoplasty. In this case, a 78-year-old man with a history that having taken Aspirin without the doctor’s instruction for 5-6 years,he underwent cervical laminoplasty for mild myelopathy. On the 3rd postoperative day, he complained of weakness of his left upper extremity and could not raise his left arm. The symptom aggravated in the next few days. On the 9th postoperative day, there was an obvious motor deficit of both upper and lower extremities. Magnetic resonance imaging demonstrated abnormal signal characteristics consistent with a hematoma at levels C3-C4, compressing spinal cord. The clot was evacuated during emergency revision surgery, and the postoperative course after the operation was uneventful and the muscle strength was improved five days later. Therefore, the symptoms of DPSEH are not so typical that its possibility should be kept in mind. Sometimes a differential diagnosis should be made with C5 nerve root palsy which may only represent weakness of upper extremities. The authors recommend that magnetic resonance imaging is helpful for the diagnosis of DPSEH and a revision surgery should be taken as soon as possible once the hematoma causing the neurologic deterioration was confirmed.