Suspension of the spinal dura mater to the corpectomy cage with tack-up sutures for bleeding control and prevention of epidural hematoma: Operative technique
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Department of Neurosurgery, Ataturk University, Erzurum, Turkey
Department of Neurosurgery, Mustafa Kemal University, Hatay, Turkey
Submission date: 2016-01-21
Acceptance date: 2017-05-10
Online publication date: 2018-06-29
Publication date: 2019-11-19
Corresponding author
Mürteza Çakır   

Neurosurgery and Emergency Department, Atatürk University, Medical School Research Hospital, 2500, Erzurum, Turkey. Tel.: +90 442 231 83 67.
Pol. Ann. Med. 2018;25(2):254-257
Postoperative spinal epidural hematoma (PSEH) is a rare complication of spinal surgery that requires surgery in very few patients. Unless prompt diagnosis and intervention is performed, neurologic deficits and mortality may occur depending on the localization of the PSEH.

In this report, we present a case that underwent tack-up suture technique with the suspension of the spinal dura mater to the corpectomy cage for bleeding control and prevention of epidural hematoma.

Case study:
A 70-year-old male patient was admitted with paresis on the right arm. MRI showed protrusion and grade 2 spondylolisthesis at C3–C4, obliteration of anterior cerebrospinal fluid column caused by osteophytes at C4–C5–C6, and loss of intervertebral disc height and degenerative fusion at the same level. C4–C5 anterior corpectomy and instrumentation was performed. Two hours after surgery, neurologic deficits developed and an epidural hematoma was detected on MRI. The patient underwent a revision surgery and hemostasis was achieved by the suspension technique. Neurologic deficits recovered postoperatively. Postoperative MRI showed the suspension of dura like a tent and no hematoma in the epidural space.

Results and discussion:
Prevention of PSEH in addition to prompt diagnosis and surgical intervention is highly important for the prevention of adverse outcomes. In our case, we achieved successful hemostasis by suspending the dura to implanted instrument in the paravertebral region.

Suspension of the dura with tack-up sutures can be a useful technique for the prevention of PSEH and risk of cord compression.

None declared.
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