Delayed arterial symptomatic epidural hematoma on the 14th day after posterior lumbar interbody fusion: A case report

Figure 1 Pre-operative radiographs. The intervertebral space of the 4^th/5^th lumbar vertebrae became smaller. A: The pre-operative anterior position radiograph; B: The pre-operative lateral position radiograph. R: Right direction.

Figure 2 Pre-operative computed tomography scans. The position (horizontal line) of the computed tomography scan shown that there is a herniated disc of the 4^th/5^th lumbar vertebrae. A: The level of the 4^th/5^th lumbar vertebrae; B: The herniated disc of the 4^th/5^th lumbar vertebrae.

Figure 3 Pre-operative magnetic resonance imaging scans. The position (horizontal line) of the magnetic resonance imaging scan shown that there is a herniated disc of the 4^th/5^th lumbar vertebrae. A: The level of the 4^th/5^th lumbar vertebrae; B: The herniated disc of the 4^th/5^th lumbar vertebrae.

Figure 4 Post-operative radiographs. The satisfactory positions of the lumbar spine internal fixation and fusion cage on post-operative 4-d. A: The post-operative 4-d anterior position radiograph; B: The post-operative 4-d lateral position radiograph. R: Right direction.

Figure 5 Post-operative magnetic resonance imaging films. The position (horizontal line) of the magnetic resonance imaging scan shown that there is an abnormal signal in the left area of the 4^th/5^th lumbar vertebral body. The white arrow indicates the hematoma. A: The level of the 4^th/5^th lumbar vertebrae; B: The abnormal signal in the left area of the 4^th/5^th lumbar vertebrae.

Figure 6 The puncture treatment films. Under C-arm X-ray machine fluoroscopy, the puncture needle in the left-side of 4^th/5^th lumbar vertebrae, bright red blood gushing out of the puncture needle core with continuous pulsation. A: The anterior position under C-arm X-ray machine fluoroscopy; B: The lateral position under C-arm X-ray machine fluoroscopy; C: The bright red blood gushing out of the puncture needle core with continuous pulsation.

Figure 7 Surgery for hematoma removal. The incision filled with hematoma that the removed hematoma is about 70 mL. White arrows indicate the hematoma. A: The incision filled with hematoma; B: The removed hematoma.

Figure 8 X-ray radiographs taken 9 mo post-operatively. The satisfactory positions of the lumbar spine internal fixation and fusion cage during a 9-mo period. A: The post-operative 9-mo anterior position radiograph; B: The post-operative 9-mo lateral position radiograph. R: Right direction.

Figure 9 X-ray radiographs taken 12 mo post-operatively. The satisfactory positions of the lumbar spine internal fixation and fusion cage during a 12-mo period. A: The post-operative 12-mo anterior position radiograph; B: The post-operative 12-mo lateral position radiograph. R: Right direction.