Incidence of Spinal Epidural Hematoma After Anterior Cervical Decompression and Fusion: Systematic Review, Meta-Analysis, and Case Report

Introduction

Anterior cervical discectomy and fusion (ACDF) is a common surgical procedure used to treat herniated discs, degenerative disc disease, and nerve root compression in the cervical spine. This systematic literature review aims to analyze the available literature on the incidence, risk factors, clinical considerations, and available therapies for spinal epidural hematoma (SEH) following ACDF.

Methods

A systematic search was conducted in PubMed, Google Scholar, and Embase from database inception to June 18, 2025, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. The search yielded 71 studies without duplicates. After applying the inclusion and exclusion criteria, 5 studies were selected for the final analysis.

Results

The overall incidence of SEH following ACDF was 0.835%. Most patients presented with dyspnea, paraplegia, or quadriplegia. A meta-analysis of the 5 studies (n = 3246; 28 events) confirmed this incidence, with moderate heterogeneity. Management varied on the basis of symptom severity, hematoma size, and neurological impairment. Surgical decompression was the most common treatment, although some cases were managed conservatively with success. SEH onset ranged from within 24 hours postoperatively to several days after surgery.

Conclusions

Although uncommon, SEH after ACDF carries significant clinical risks. Preventive measures may help mitigate its occurrence. However, the limited literature prevents a precise determination of the incidence and associated risk factors, including coagulation disorders. There is a clear need for large-scale prospective and retrospective studies with standardized reporting to more accurately define the incidence, identify risk factors, and determine the optimal management of SEH following ACDF.