Catheter-assisted evacuation through limited laminectomy for traumatic long-segment spinal epidural hematoma in ankylosing spondylitis: a technical note and two case reports

Patients with ankylosing spondylitis (AS) are prone to unstable spinal fractures with long-segment spinal epidural hematoma (LSEH). Conventional multilevel laminectomy can achieve complete decompression but may disrupt the posterior tension complex. In this article, we describe a catheter-assisted technique for evacuating LSEH through a limited laminectomy window. Two AS patients with traumatic cervicothoracic LSEH underwent emergency posterior stabilization followed by limited laminectomy. A 15 Fr silicone catheter with a distal side-hole was advanced epidurally along the hematoma through the laminectomy window. We applied alternating negative-pressure suction and intermittent saline irrigation until free backflow was achieved and dural decompression was confirmed. Complete radiographic decompression was obtained in both cases and their neurological recovery was substantial. Case 1 improved from Japanese Orthopaedic Association (JOA) score 3/17 and American Spinal Injury Association (ASIA) classification B preoperatively to JOA 16/17 and ASIA E at 6 months post operation, regaining independent ambulation. Case 2, presenting with JOA 0/17 and ASIA A pre-operation, improved to JOA 9/17 and ASIA C at final follow-up, with a recovery of deep sensation and partial motor function. Catheter-assisted evacuation via limited laminectomy represents a feasible approach for LSEH in AS patients. This technique facilitates effective decompression while minimizing damage to posterior spinal structures.