Post-laminectomy Hematoma Formation in a Patient with Multiple Comorbidities

Introduction: Minimally invasive laminectomy is a common procedure for relieving spinal stenosis and neurogenic claudication. While generally safe, complications like hematoma formation can occur, especially in patients with multiple comorbidities. This report discusses a complex case involving both local and remote hematomas after minimally invasive laminectomy, highlighting the challenges in high-risk patient management.

Methods: A 70-year-old male with a medical history significant for hypertension, hyperlipidemia, gastroesophageal reflux disease, gout, liver cirrhosis from hepatitis C, chronic kidney disease stage III, and depression presented with chronic low back pain and neurogenic claudication. Preoperative imaging showed severe stenosis at L3-L4, and he underwent a left L3-L4 minimally invasive laminectomy and medial facetectomy. The surgery was challenging due to large facet joints requiring extensive drilling. Initially stable postoperatively, he developed new-onset groin numbness on day two. MRI revealed a hematoma at the surgical site and an unexpected remote epidural hematoma from T12 to L4, causing multilevel cauda equina compression. The patient was not on anticoagulants and had no known coagulopathies. Neurosurgical consultation recommended conservative management due to the patient's stable neurological status and multiple comorbidities.

Results: The formation of both local and remote hematomas post-laminectomy in a patient without anticoagulation therapy is unusual. Potential factors include altered hemodynamics and extensive intraoperative drilling in the context of the patient's comorbidities. This case underscores the importance of meticulous surgical technique and vigilant postoperative monitoring in high-risk patients. The management dilemma is compounded when surgical intervention poses significant risk due to comorbid conditions.

Conclusion : This case highlights the complexity of managing postoperative complications in patients with multiple comorbidities. Careful preoperative planning, surgical execution, and postoperative vigilance are critical. Conservative management may be appropriate in select cases, but clinicians must weigh the risks and benefits carefully. Further research is needed to develop guidelines for managing similar high-risk patients undergoing spinal procedures.