To report a rare case of acute postoperative epidural hematoma (PEDH) following unilateral biportal endoscopic (UBE) unilateral laminotomy with bilateral decompression (ULBD) for L3–4 spinal stenosis, presumably caused by muscular hemorrhage, and to explore its potential etiology through a review of the literature.
Approach:
Clinical Data Collection: Pre- and postoperative Visual Analog Scale (VAS) and Japanese Orthopaedic Association (JOA) scores were recorded at key timepoints.
Literature Review: A review of existing literature was conducted to contextualize the findings.
Key Findings:
A 56-year-old male experienced acute PEDH after UBE-ULBD surgery, with significant pain and MRI-confirmed hematoma.
Emergency debridement revealed continuous bleeding from a small muscular artery, leading to hematoma accumulation.
Post-debridement, the patient's pain improved significantly (VAS 3), and he was discharged without sequelae.
Interpretation:
Spinal postoperative epidural hematomas occur in 0.1%–3% of cases, with this being the first documented instance following UBE-ULBD surgery.
Limitations:
The case report is based on a single patient, limiting generalizability.
Potential biases in reporting and literature review may affect the conclusions.
Conclusion:
Meticulous intraoperative hemostasis is essential, especially after restoring baseline blood pressure. Immediate surgical intervention within 24 hours is crucial for alleviating neurological compression.
