# Multilevel Cervical Epidural Hematoma From C1 to T3 Following C6/C7 Anterior Cervical Discectomy and Fusion (ACDF): A Rare but Reversible Surgical Emergency

## TL;DR

A rare spinal hematoma after neck surgery was successfully treated with a novel minimally invasive technique, leading to full recovery.

## Contribution

A new minimally invasive surgical technique using ventricular catheters and hydrogen peroxide for treating postoperative spinal epidural hematoma is proposed.

## Key findings

- An urgent anterior revision surgery with catheter-based saline lavage resolved a multilevel cervical epidural hematoma.
- Hydrogen peroxide effectively controlled active bleeding unresponsive to conventional hemostatic methods.
- The patient achieved full neurological recovery and complete hematoma resolution within five postoperative days.

## Abstract

Postoperative spinal epidural hematoma (SEH) is a rare but potentially devastating complication following anterior cervical discectomy and fusion (ACDF). We report a case of a 60-year-old man who developed an extensive cervical SEH from C1 to T3 after undergoing C6/C7 ACDF. The patient presented with acute tetraparesis and respiratory failure necessitating immediate intubation. A computed tomography (CT) scan revealed a multilevel epidural hematoma extending anteriorly from the craniovertebral junction to the upper thoracic spine. We performed an urgent anterior revision surgery. The previously inserted ACDF cage was removed, and two ventricular catheters (Neuromedex GmbH, Hamburg, Germany), with an outer diameter of 3.0 mm and an inner diameter of 1.5 mm, were inserted cranially and caudally for saline lavage. Active bleeding was identified posterior to the C7 vertebra, which did not respond to conventional hemostatic sponges but was successfully controlled using hydrogen peroxide (H2O2). Postoperatively, the patient exhibited immediate neurological recovery and was discharged without deficits on postoperative day five. Follow-up CT imaging demonstrated complete resolution of the hematoma. This case emphasizes the need for high suspicion and prompt surgical management in cases of postoperative SEH. Our technique may offer a valuable minimally invasive method for hematoma evacuation in similar emergencies.