Delayed epidural hematoma after spinal cord stimulator implantation in a patient with von Willebrand disease: Illustration.

Background: A patient with von Willebrand disease developed a delayed epidural hematoma originating from the tunneling tract and gluteal generator pocket following the placement of a thoracic spinal cord stimulator (SCS).

Case description: A 43-year-old male with von Willebrand disease underwent thoracic SCS placement to treat chronic bilateral lower extremity pain with paresthesias in 2024. The patient had previously experienced a postoperative hematoma in 2010. At the time of the thoracic SCS placement, he received 7 days of prophylactic antihemophilic factor/von Willebrand factor complex therapy. One month following placement of the thoracic SCS, the patient noted significant swelling localized to the thoracic and buttock incisions. Exploratory surgery documented an additional hematoma tracking from the tunneling tract and gluteal generator pocket all the way into the epidural space; it was promptly removed. At the 6-month follow-up, he exhibited no further wounds or neurological issues.

Conclusion: Patients with coagulopathies, and critically, von Willebrand disease, undergoing SCS placement are at increased risk for postoperative hematomas.