Could Unilateral Biportal Endoscopy-Assisted Thoracic Interbody Fusion Be the Answer for Multiple Recurrences of Postoperative Thoracic Epidural Hematoma After Unilateral Biportal Endoscopic Decompression Surgery? A Case Report and Technical Note
10.21182/jmisst.2025.02089
- Author:
Piyush W. GADEGONE
1
;
Ji Soo HA
;
Shreenidhi KULKARNI
;
Do-Hyoung KIM
;
Chang-Wook KIM
;
Rajendra SAKHREKAR
;
Hee-Don HAN
Author Information
1. Yonsei Okay Hospital, Uijeongbu, Korea
- Publication Type:Case Report
- From:
Journal of Minimally Invasive Spine Surgery and Technique
2025;10(Suppl 2):S261-S269
- CountryRepublic of Korea
- Language:English
-
Abstract:
Postoperative thoracic epidural hematoma (PTEH) is a rare and complex condition that can lead to significant neurological deficits, persistent pain, and reduced functional abilities. Despite advancements in minimally invasive techniques such as unilateral biportal endoscopic (UBE) decompression, recurrence of PTEH remains a challenging clinical issue. This case report describes the innovative application of unilateral biportal endoscopy-assisted thoracic interbody fusion to manage recurrent thoracic idiopathic epidural hematoma. We discuss the surgical technique, clinical outcomes, and potential benefits of this method in reducing recurrence and stabilizing the thoracic spine. A 78-year-old woman without comorbidities underwent UBE decompression for symptomatic D11–12 and L1–2 spinal stenosis. She later developed delayed postoperative spinal epidural hematoma (SEH), causing paraparesis and bowel/bladder dysfunction. Despite 2 successful emergency hematoma evacuations with magnetic resonance imaging-confirmed clearance and symptom improvement, recurrences continued to take place, each occurring within shorter intervals. At the third recurrence, occult spinal microinstability was suspected as the cause of persistent bleeding. Unilateral biportal endoscopy-assisted thoracic interbody fusion was performed to address this issue. After fusion surgery, the patient experienced no further hematoma recurrences and fully regained neurological and functional capabilities at the 9-month follow-up. While surgical decompression is the standard for SEH, recurrent or delayed postoperative cases require a tailored approach. This case underscores the importance of considering thoracic interbody fusion for recurrent SEH to address microinstability and ongoing bleeding. Unilateral biportal endoscopy-assisted fusion offers a minimally invasive yet definitive solution, highlighting the need for individualized surgical strategies to achieve optimal outcomes.
