Post-Operative Epidural Hematoma¶
Definition¶
Post-operative spinal epidural hematoma is a potentially devastating complication of spinal surgery, occurring in approximately 0.1–0.2% of spinal procedures. It develops within hours to days after surgery and can cause acute cord or cauda equina compression requiring emergency reoperation.
Imaging Findings¶
MRI¶
- Epidural collection in the surgical bed, posterior to the thecal sac
- Signal follows the standard hemorrhage evolution — acute blood is isointense on T1, low on T2 (deoxyhemoglobin)
- Mass effect — Compression of the thecal sac and displacement of the cord or nerve roots
- Cord signal change — T2 hyperintensity in the cord indicates myelopathy from compression
- Small epidural hematomas are common and expected after surgery — clinical significance depends on size and mass effect
CT¶
- Hyperdense epidural collection (acute blood)
- Useful when MRI is not immediately available
Clinical Pearl
A post-operative patient with acute neurological deterioration (new weakness, bowel/bladder dysfunction) within 24–72 hours of spinal surgery should be considered for emergent epidural hematoma until proven otherwise. Urgent MRI (or CT if MRI unavailable) and emergent surgical evacuation if confirmed. Time to decompression directly affects neurological outcome.
Key Points¶
- Acute post-operative complication — hours to days after surgery
- Epidural collection with mass effect on the thecal sac/cord
- Urgent MRI and emergent reoperation for symptomatic hematomas
- Small post-operative epidural collections are common and usually asymptomatic
- Time to decompression correlates with neurological outcome
References¶
- Pierce JL, Donahue JH, Nacey NC, Quirk CR, Perry MT, Faulconer N, et al. Spinal hematomas: what a radiologist needs to know. RadioGraphics. 2018;38(5):1516-1535. doi:10.1148/rg.2018180099. PMID: 30207937.
- Chen Q, Zhong X, Liu W, Wong C, He Q, Chen Y. Incidence of postoperative symptomatic spinal epidural hematoma requiring surgical evacuation: a systematic review and meta-analysis. Eur Spine J. 2022;31(12):3274-3285. doi:10.1007/s00586-022-07421-6. PMID: 36260132.
- Amiri AR, Fouyas IP, Cro S, Casey ATH. Postoperative spinal epidural hematoma (SEH): incidence, risk factors, onset, and management. Spine J. 2013;13(2):134-140. doi:10.1016/j.spinee.2012.10.028. PMID: 23218510.
- Yi S, Yoon DH, Kim KN, Kim SH, Shin HC. Postoperative spinal epidural hematoma: risk factor and clinical outcome. Yonsei Med J. 2006;47(3):326-332. doi:10.3349/ymj.2006.47.3.326. PMID: 16807981.
- Leonardi MA, Zanetti M, Saupe N, Min K. Early postoperative MRI in detecting hematoma and dural compression after lumbar spinal decompression: prospective study of asymptomatic patients in comparison to patients requiring surgical revision. Eur Spine J. 2010;19(12):2216-2222. doi:10.1007/s00586-010-1483-x. PMID: 20556438.
- Moriarty HK, Cearbhaill RO, Moriarty PD, Stanley E, Lawler LP, Kavanagh EC. MR imaging of spinal haematoma: a pictorial review. Br J Radiol. 2019;92(1095):20180532. doi:10.1259/bjr.20180532. PMID: 30407845.
- Gaillard F, et al. Spinal epidural hematoma. Radiopaedia.org. Available from: https://radiopaedia.org/articles/spinal-epidural-hematoma-2