2. Department of Anesthesiology Medicine, School of Medicine, Inje university Busan paik hospital, Bok Ji Ro 75, Busanjin-Ku, Busan, South Korea.
A fifty-four-year-old man was admitted with left leg severe radiating pain with a history of previous lumbar spinal fusion(L5/S1) presented with upper adjacent level spinal stenosis. He underwent a revision spinal arthrodesis from L4 to L5. Dissection at adhesion lesion in L4/5 level resulted in a unintended 3-mm dural tear with CSF loss. The durotomy was primarily repaired during the surgery. Total perioperative blood loss was 1900 mL and fliud replacement was about 4000 mL. On the fourth postoperative day, the patient had slightly headache. He was treated conservatively (Hydration and NSAIDs). On the tenth day, the patient complained of severe headache with the nousea, vomiting. A brain CT was obtained and revealed acute subdural hematoma in left frontoparietal area. We did not have surgery because of no intracerebral mass effect, but follow up brain CT. The hematoma was not increased and resolved. The patient made an uneventful recovery. This case reminds that subdural hematoma can complicate durotomy during spine surgery. Therefore, neurological deterioraion in the postoperative period rule out the diagnosis, especially in complicated by dural tears on revisional spinal operation.
Keywords: Acute subdural hematoma, headache, spinal stenosis, spinal arthrodesis