Epidural Hematoma Causing Dense Paralysis After Anterior Cervical Corpectomy: A Report of Two Cases

P aralysis after anterior cervical spine surgery is an uncommon, albeit devastating, complication. Flynn analyzed data from 36,657 anterior cervical interbody arthrodeses performed by 704 neurosurgeons and noted that only 100 patients (0.3%) had a permanent neurologic deficit1. Seventy-five percent of these patients exhibited symptoms of a neurologic deficit immediately on emergence from anesthesia, whereas 25% exhibited symptoms early in the postoperative recovery period. The most common causes of spinal cord injury during cervical spine surgery include surgical trauma, vascular compromise, graft impingement, instrument misplacement, and spinal manipulation. One of the less common complications that can cause major neurologic morbidity is an expanding epidural hematoma at the surgical site. A hematoma can develop slowly in the corpectomy or discectomy site and may cause compression of the spinal cord. Unfortunately, there is a dearth of literature addressing this issue2,3. This scarcity may be due not only to the exceptionally low prevalence of a compressive hematoma but also to the difficulty in defining the exact cause of paralysis after surgery1. Multimodality neurophysiological monitoring has proven to be highly beneficial in minimizing spinal cord injury during spine surgery4-10. Recent evidence has shown marked improvement in the sensitivity to injury detection during cervical spine surgery with transcranial electric motor evoked potential (tceMEP) monitoring compared with somatosensory evoked potential (SSEP) monitoring alone7,8. We present the cases of two patients to highlight the role of tceMEP monitoring in the early detection and intervention of an expanding epidural hematoma. Our patients were informed that data from the cases would be submitted for publication. C ase 1. A seventy-four-year-old man with symptoms of progressive cervical myelopathy underwent an anterior cervical corpectomy and arthrodesis for decompression of the spinal cord. The spinal cord …