Published online Jul 16, 2023. doi: 10.12998/wjcc.v11.i20.4890
Peer-review started: November 7, 2022
First decision: January 12, 2023
Revised: January 21, 2023
Accepted: June 13, 2023
Article in press: June 13, 2023
Published online: July 16, 2023
Processing time: 246 Days and 16.5 Hours
Acute spinal subdural haematoma (ASSH) is a rare and potentially devastating condition with a variable prognosis. Previously described subdural haematomas were thought to have occurred spontaneously or be related to major or minor iatrogenic or traumatic injuries caused by surgery, spinal puncture or epidural anaesthesia. Other contributing pathologies have been described, such as intradural tumours or spinal arteriovenous malformations. ASSH has also been associated with anticoagulation therapy, haemostatic abnormalities and risk factors such as pregnancy. To the best of our knowledge, this case study described the first reported occurrence of an ASSH during spinal surgery in a paediatric patient. The patient was not known to have any coagulopathies, and no obvious vascular lesions were documented. The surgical procedure did not directly involve the dura mater, and no evident intraoperative dural tears were found.
We reported and discussed a case of ASSH complicating a posterior spinal instrumented fusion during surgery for paediatric congenital scoliosis. This condition has not been previously described. We made recommendations for facing such an occurrence, explored its aetiology in the context of malformation and discussed the benefits of neuromonitoring during scoliosis correction and the management protocol. We conducted a PubMed literature review for cases of paediatric ASSH and other closely related disorders. We reviewed recommendations regarding neuromonitoring and treatment management in such cases.
ASSH is a rare complication of posterior spinal instrumented fusion. Published cases are more often associated with anticoagulation therapy or coagulopathy. Neuromonitoring is strongly recommended to detect and assess neurological status, thus enabling rapid diagnosis and treatment and facilitating early spinal decompression and a return to a normal neurological status.
Core Tip: Acute spinal subdural haematoma is a rare complication of posterior spinal instrumented fusion. The context of the spine deformity and associated congenital abnormalities, the use of neuromonitoring in such surgery and the management of acute spinal subdural haematoma are discussed. Published cases are more often associated with anticoagulation therapy or coagulopathy. Neuromonitoring is strongly recommended to detect and assess neurological status, enabling rapid diagnosis and treatment, thus allowing early spinal decompression and a return to a normal neurological status.