title: Recurrent Postoperative Spinal Epidural Hematoma in a Patient with Protein S Deficiency.
abstract: A 71-year-old man underwent cervical laminectomy and developed two symptomatic epidural hematomas during the acute postoperative period. On both occasions, drain obstruction was the predominant cause. Congenital Protein S deficiency was diagnosed postoperatively. Protein S is a vitamin K-dependent natural anticoagulant and is essential for inhibiting thrombosis in microcirculation. We assume that Protein S deficiency followed by perioperative bed-rest and surgical invasiveness led to severe hypercoagulability and subsequent drain obstruction. The present findings suggest that both bleeding disorders and hypercoagulability are risk factors for postoperative symptomatic epidural hematoma.
authors.affiliation: Department of Orthopaedic Surgery, Musashino Red Cross Hospital, 1-26-1 Kyonan-cho, Musashino-shi, Tokyo 1800023, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Anno
authors.affiliation: Department of Orthopaedic Surgery, Musashino Red Cross Hospital, 1-26-1 Kyonan-cho, Musashino-shi, Tokyo 1800023, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamazaki
authors.affiliation: Department of Orthopaedic Surgery, Musashino Red Cross Hospital, 1-26-1 Kyonan-cho, Musashino-shi, Tokyo 1800023, Japan.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Hara
authors.affiliation: Department of Orthopaedic Surgery, Musashino Red Cross Hospital, 1-26-1 Kyonan-cho, Musashino-shi, Tokyo 1800023, Japan.
authors.forename: Keishi
authors.initials: K
authors.lastname: Hayakawa