The authors describe a case of postoperative
spinal epidural hematoma (PSEH) that developed in a patient 9 days after he underwent
laminoplasty. A PSEH is a rare but critical complication of spinal surgery that usually occurs within a few days of the procedure. The authors draw attention to the possibility of delayed PSEH and its triggering mechanism. In this case, a 59-year-old man with no history of
bleeding disorder underwent cervical
laminoplasty for mild
myelopathy. On the 7th postoperative day computed tomography demonstrated no abnormal findings in the operative field. On the 9th postoperative day, while straining to defecate, the patient suddenly felt neck and
shoulder pain, and
tetraplegia rapidly developed. Magnetic resonance imaging demonstrated a huge epidural
hematoma. The clot was evacuated during emergency
revision surgery, during which the arterial
bleeding from a split muscle wall was confirmed. The postoperative course after the
revision surgery was uneventful and the patient had none of the previous symptoms 1 year later. A PSEH causing
paralysis can occur even more than a week after surgery. The possibility of a delayed-onset PSEH should be kept in mind, and prompt diagnosis should be made when a patient presents with
paresis or
paralysis after an operation. The authors recommend advising patients that for a while after surgery they avoid strenuous activity.