title: Ultra-delayed lumbar surgical wound hematoma.
abstract: BACKGROUND
  There exists an inherent risk of increased venous thromboembolism (VTE) in surgical spine patients, which is independent of their existing risk factors. Prophylaxis and treatment of VTE is an imprecise practice and may have serious complications even well after the initial surgery. Furthermore, there are no clear guidelines on how to manage postoperative spine patients with regards to the timing of anticoagulation.
  
  
  METHODS
  Here, we present the case of a middle-aged male, status post L2/3 laminectomy and discectomy who developed bilateral below the knee deep venous thrombosis. He was started on Enoxaparin and transitioned to Warfarin and returned with axial back pain, and was found to have a postoperative hematoma almost 3 weeks later in a delayed fashion.
  
  
  CONCLUSIONS
  Delayed surgical wound hematoma with neural compression is an important complication to identify and should remain high on the differential diagnosis in patients on warfarin who present with axial spinal pain.
authors.affiliation: Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: Merritt D
authors.initials: MD
authors.lastname: Kinon
authors.affiliation: Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Nakhla
authors.affiliation: Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: Kenroy
authors.initials: K
authors.lastname: Brown
authors.affiliation: Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: Niketh
authors.initials: N
authors.lastname: Bhashyam
authors.affiliation: Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: Reza
authors.initials: R
authors.lastname: Yassari
keywords: Anticoagulation; complication; spinal decompression; venous thromboembolism; wound hematoma