Emergency Management of Extensive Spinal Epidural Hematoma Causing Medullary Compression After Single-Level Anterior Cervical Discectomy and Fusion (ACDF): A Novel Segmental Decompression and Catheter Irrigation Strategy.

Here, we present a retrospective analysis of a 48-year-old male patient who developed a rare complication of extensive spinal epidural hematoma (SEH) with spinal cord and medullary compression following single-level anterior cervical discectomy and fusion (ACDF), manifesting as acute dyspnea, coma, and quadriplegia. The emergency treatment entailed anterior segmental decompression under general anesthesia, removal of internal fixation devices, and targeted catheter irrigation to evacuate the hematoma spanning from C1 to C7. Postoperatively, the patient demonstrated remarkable neurological recovery, with the American Spinal Injury Association (ASIA) impairment grade improving from preoperative grade A (complete paralysis) to grade E (normal function), and was discharged after uneventful rehabilitation. This case highlights that despite the low incidence of SEH after cervical spine surgery, prompt intervention with segmental decompression combined with catheter irrigation offers a novel, low-trauma, and efficient strategy for managing life-threatening medullary compression, achieving rapid hematoma clearance and favorable functional outcomes.