title: Full-endoscopic interlaminar removal of chronic lumbar epidural hematoma after spinal manipulation.
abstract: BACKGROUND
  Spinal manipulation is widely used for low back pain treatments. Complications associated with spinal manipulation are seen. Lumbar epidural hematoma (EDH) is one of the complications reported in the literature. If lumbar chronic EDH symptoms are present, which are similar to those of a herniated nucleus pulposus, surgery may be considered if medical treatment fails. Percutaneous endoscopic discectomy utilizing an interlaminar approach can be successfully applied to those with herniated nucleus pulposus. We use the same technique to remove the lumbar chronic EDH, which is the first documented report in the related literature.
  
  
  METHODS
  We present a case with chronic lumbar EDH associated with spinal manipulation. Neurologic deficits were noted on physical examination. We arranged for a full-endoscopic interlaminar approach to remove the hematoma for the patient with the rigid endoscopy (Vertebris system; Richard Wolf, Knittlingen, Germany).
  
  
  RESULTS
  After surgery, the patient's radiculopathy immediately began to disappear. Magnetic resonance imaging (MRI) follow-up 10 days after the surgery revealed no residual hematoma. No complications were noted during the outpatient department follow up.
  
  
  CONCLUSIONS
  Lumbar EDH is a possible complication of spinal manipulation. Patient experiencing rapidly progressive neurologic deficit require early surgical evacuation, while conservative treatment may only be applied to those with mild symptoms. A percutaneous full-endoscopic interlaminar approach may be a viable alternative for the treatment of those with chronic EDH with progressive neurologic deficits.
authors.affiliation: Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Yen-Po
authors.initials: YP
authors.lastname: Cheng
authors.affiliation: Department of Medical Imaging, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Kwo-Whei
authors.initials: KW
authors.lastname: Lee
authors.affiliation: Transplant Medicine and Surgery Research Centre, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Ping-Yi
authors.initials: PY
authors.lastname: Lin
authors.affiliation: Department of Neurosurgery, Department of Surgery, National Taiwan University Hospital, and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Abel Po-Hao
authors.initials: AP
authors.lastname: Huang
authors.affiliation: Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Chun-Yuan
authors.initials: CY
authors.lastname: Cheng
authors.affiliation: Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Hsin-I
authors.initials: HI
authors.lastname: Ma
authors.affiliation: Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Chien-Min
authors.initials: CM
authors.lastname: Chen
authors.affiliation: Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Dueng-Yuan
authors.initials: DY
authors.lastname: Hueng
keywords: Chronic epidural hematoma; endoscopic; interlaminar; lumbar; spinal manipulation