Paraplegia Caused by a Large Spinal Epidural Hematoma 12 Days After Thoracic Decompression and Fusion.

A 41-year-old man with a history of obesity, hypertension, and smoking suffered from numbness and weakness in both lower limbs. He was diagnosed with ossification of the posterior longitudinal ligament and ligamentum flavum in the cervical and thoracic spine by X-rays, CT, and MRI. The patient underwent laminectomies at T2 and T3 levels, along with posterior fusion from T1 to T4, to address an upper thoracic spine lesion causing sensory deficits up to T5 and gait disturbances. The surgeries were T2 and T3 laminectomies and posterior T1-T4 fusion. The intraoperative and postoperative courses were uneventful. However, on the twelfth postoperative day, the patient suddenly experienced severe back pain followed by complete paralysis of both lower extremities, accompanied by significant swelling at the surgical site. An urgent MRI revealed a large hematoma dorsal to the dura mater, extending from T1 to T4. Emergent evacuation of the hematoma was performed, and no active bleeding was observed. Over time, a gradual improvement in the strength of the lower limbs was observed. Follow-up at two years postoperatively indicated the patient could walk unassisted for up to 1 km, although he continued to experience nocturnal urinary incontinence and erectile dysfunction. This case highlights the importance of recognizing that postoperative spinal epidural hematoma can develop even more than 10 days after spinal surgery. Patient and staff education is crucial to ensure prompt recognition and intervention.