Compressive spontaneous spinal epidural hematoma following cervical laminoplasty and the role of multimodal neuromonitoring: a case report.

Background: Cervical myelopathy is a clinical syndrome resulting from cord compression at the level of the cervical spine characterized by fine motor, sphincter, and gait dysfunction, for which early surgical management is the mainstay of therapy. Identification of techniques to monitor for and facilitate early management of rare but serious neurologic complications following cervical spine surgery is of the utmost importance. Intraoperative neuromonitoring (IONM) is one such technique that may be employed to identify neurologic injury in a timely manner including those events occurring remote to the operative levels. Case Description: In this report, we describe the case of a 77-year-old male with a complicated medical history who sustained intraoperative spinal cord injury caudal to the instrumented levels during a cervical laminoplasty. Neurologic change was detected on IONM leading to emergent imaging. Spinal epidural hematoma was identified, which led to prompt surgical intervention resulting in return to preoperative neurologic baseline within 24 hours postoperatively. Conclusions: IONM facilitates early identification and allows for prompt management of potential neurologic adverse events including those caudal to operative levels during spine surgery and may reduce or reverse associated morbidity and mortality. We hope this case highlights the importance of further study into this modality to determine its optimal use in elective spine surgery.