Delayed-onset spinal subdural hematoma after kyphoplasty.

Background: Spinal subdural hematoma (SDH) is a very rare complication of percutaneous balloon kyphoplasty. Here, a 66-year-old male developed delayed-onset spinal SDH following kyphoplasty.

Case description: A 66-year-old male with a history of atrial fibrillation on Eliquis developed a SDH on day 4 following a T3 single-level kyphoplasty for an osteoporotic compression fracture. The patient presented with progressive lower extremity motor/sensory paralysis that eventually ascended to the cervical region. The magnetic resonance (MR) imaging revealed a large dorsal subdural hematoma extending from T1 to S2. The patient underwent a decompressive laminectomy for hematoma to remove cement fragments and repair a dural tear. Postoperatively, the patient partially recovered sensation but no motor function and expired in the intensive care unit due to major comorbid factors.

Conclusion: SDH is a potentially serious risk of performing a kyphoplasty. This is particularly true for patients on anticoagulants who should be stringently monitored with MR if indicated to avoid a major postoperative hemorrhage and paralysis.