Postoperative Acute Lumbar Epidural Hematoma With White Clot Formation Causing Cauda Equina Syndrome: A Case Report and Review of the Literature

Ioannis D. Gelalis, Angelos N. Politis, Christina M. Arnaoutoglou, Athanasios C. Karageorgos, Nikolaos K. Paschos, Avraam Ploumis, Theodoros A. Xenakis


While the majority of spinal epidural hematomas after a spinal operation are clinically asymptomatic, the reported percentage of hematomas needing surgical evacuation is only 0.1%. A 69-year-old woman presented after a rapidly progressive worsening of her neurologic status at both legs. The patient was under anticoagulant medication with acenocoumarol due to atrial fibrillation and underwent a decompression laminectomy and L5, S1 left nerve root decompression. Eleven hours after the operation she presented with acute progressive cauda equina syndrome due to an epidural hematoma and was immediately transferred to the operating theater. A membrane of white clot was found and the presence of epidural clotted blood beneath the membrane was verified. The surgeon must be aware of this catastrophic complication that requires a high level of suspicion and prompt intervention. Large, multicentre prospective, randomized studies are needed to fully investigate the risks of anticoagulation therapy after spinal surgery.

J Med Cases. 2012;3(1):76-80


White clot; Epidural hematoma; Anticoagulation; Lumbar spinal stenosis; Laminectomy

Full Text: HTML PDF

Browse  Journals  


Journal of Clinical Medicine Research

Journal of Endocrinology and Metabolism

Journal of Clinical Gynecology and Obstetrics


World Journal of Oncology

Gastroenterology Research

Journal of Hematology


Journal of Medical Cases

Journal of Current Surgery

Clinical Infection and Immunity


Cardiology Research

World Journal of Nephrology and Urology

Cellular and Molecular Medicine Research


Journal of Neurology Research

International Journal of Clinical Pediatrics



Journal of Medical Cases, monthly, ISSN 1923-4155 (print), 1923-4163 (online), published by Elmer Press Inc.                     
The content of this site is intended for health care professionals.
This is an open-access journal distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted
non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Creative Commons Attribution license (Attribution-NonCommercial 4.0 International CC-BY-NC 4.0)

This journal follows the International Committee of Medical Journal Editors (ICMJE) recommendations for manuscripts submitted to biomedical journals,
the Committee on Publication Ethics (COPE) guidelines, and the Principles of Transparency and Best Practice in Scholarly Publishing.

website:   editorial contact:
Address: 9225 Leslie Street, Suite 201, Richmond Hill, Ontario, L4B 3H6, Canada

© Elmer Press Inc. All Rights Reserved.

Disclaimer: The views and opinions expressed in the published articles are those of the authors and do not necessarily reflect the views or opinions of the editors and Elmer Press Inc. This website is provided for medical research and informational purposes only and does not constitute any medical advice or professional services. The information provided in this journal should not be used for diagnosis and treatment, those seeking medical advice should always consult with a licensed physician.