Intraoperative spinal subarachnoid hematoma in a patient with cervical ossification of the posterior longitudinal ligament.
METHODS
Case report.


OBJECTIVE
To report a surgically treated case of cervical ossification of the posterior longitudinal ligament (OPLL), in which a spinal subarachnoid hematoma (SSAH) developed intraoperatively but was successfully treated.


BACKGROUND
Previous reports have indicated that trauma, lumbar puncture, vascular lesions such as arteriovenous malformation, neoplastic lesions, and coagulopathy can cause SSAH. To the best of our knowledge, there has been no report that describes the occurrence of SSAH during anterior decompression surgery of the cervical spine.


METHODS
A 52-year-old man with cervical myelopathy caused by OPLL underwent surgery for anterior decompression from C2/3 to C6/7. Immediately after the OPLL floating procedure, cerebrospinal fluid leakage and massive bleeding occurred at right edge of the OPLL at the C3-C4 level. After hemostasis, the dura mater at the C5-C6 levels bulged rapidly and became cyanotic. Intraoperative ultrasonographic images showed a high-intensity mass lesion on the ventral side of the spinal cord, indicating an intrathecal hematoma.


RESULTS
We incised the dura, found the hematoma under the intact arachnoid, and removed it. We then found that the bleeding occurred from the radicular artery along the right C4 root. After hemostasis, we performed anterior spine fusion from C2-C7. After surgery, the patient's myelopathy was improved, and no neurologic deficit related to the subarachnoid hematoma was found.


CONCLUSIONS
This experience suggests that when anterior decompression surgery is performed for cervical OPLL patients, we should consider the possible occurrence of an SSAH. Intraoperative ultrasonography is a useful tool for detecting SSAHs.
Yamazaki
Masashi
M
Spine Section, Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-Ku, Chiba, Japan. masashiy@faculty.chiba-u.jp
Okawa
Akihiko
A
Fujiyoshi
Takayuki
T
Kawabe
Junko
J
Furuya
Takeo
T
Kon
Tamiyo
T
Koda
Masao
M
D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007796:Laminectomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D017887:Ossification of Posterior Longitudinal Ligament / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D013123:Spinal Fusion; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D016896:Treatment Outcome