Gregory D. Schroeder, Thomas Jefferson UniversityFollow
Alan S. Hilibrand, Thomas Jefferson UniversityFollow
Paul M. Arnold, Kansas University Medical CenterFollow
David E. Fish, UCLA Spine CenterFollow
Jeffrey C. Wang, UCLA Spine CenterFollow
Jeffrey L. Gum, Norton Leatherman Spine Center
Zachary A. Smith, Northwestern University Feinberg School of MedicineFollow
Wellington K. Hsu, Northwestern University Feinberg School of MedicineFollow
Ziya L. Gokaslan, Brown University; Rhode Island Hospital; Miriam Hospital; Norman Prince Neurosciences InstituteFollow
Robert E. Isaacs, Duke University Medical CenterFollow
Adam S. Kanter, University of Pittsburgh
Thomas E. Mroz, Cleveland Clinic
Ahmad Nassr, Mayo Clinic
Rick C. Sasso, Indiana University; Indiana Spine GroupFollow
Michael G. Fehlings, Toronto Western HospitalFollow
Zorica Buser, University of Southern California
Mohamad Bydon, Mayo Clinic
Peter I. Cha, Toronto Western Hospital
Dhananjay Chatterjee, Toronto Western Hospital
Erica L. Gee, Toronto Western Hospital
Elizabeth L. Lord, Toronto Western HospitalFollow
Erik N. Mayer, Toronto Western Hospital
Owen J. McBride, Toronto Western Hospital
Emily C. Nguyen, University of California, Los Angeles
Allison K. Roe, Toronto Western HospitalFollow
P. Justin Tortolani, Johns Hopkins Medical Institutions; Medstar Union Memorial HospitalFollow
D. Alex Stroh, University of California, Los Angeles
Marisa Y. Yanez, Toronto Western HospitalFollow
K. Daniel Riew, Columbia University; NewYork-Presbyterian/The Allen HospitalFollow

Document Type


Publication Date



This article has been peer reviewed. It is the author’s final published version in Global Spine Journal

Volume 7, Issue 1, April 2017, Pages 120S-126S.

The published version is available at DOI: 10.1177/2192568216687754. Copyright © Schroeder et al.


STUDY DESIGN: A multicentered retrospective case series.

OBJECTIVE: To determine the incidence and circumstances surrounding the development of a symptomatic postoperative epidural hematoma in the cervical spine.

METHODS: Patients who underwent cervical spine surgery between January 1, 2005, and December 31, 2011, at 23 institutions were reviewed, and all patients who developed an epidural hematoma were identified.

RESULTS: A total of 16 582 cervical spine surgeries were identified, and 15 patients developed a postoperative epidural hematoma, for a total incidence of 0.090%. Substantial variation between institutions was noted, with 11 sites reporting no epidural hematomas, and 1 site reporting an incidence of 0.76%. All patients initially presented with a neurologic deficit. Nine patients had complete resolution of the neurologic deficit after hematoma evacuation; however 2 of the 3 patients (66%) who had a delay in the diagnosis of the epidural hematoma had residual neurologic deficits compared to only 4 of the 12 patients (33%) who had no delay in the diagnosis or treatment (P = .53). Additionally, the patients who experienced a postoperative epidural hematoma did not experience any significant improvement in health-related quality-of-life metrics as a result of the index procedure at final follow-up evaluation.

CONCLUSION: This is the largest series to date to analyze the incidence of an epidural hematoma following cervical spine surgery, and this study suggest that an epidural hematoma occurs in approximately 1 out of 1000 cervical spine surgeries. Prompt diagnosis and treatment may improve the chance of making a complete neurologic recovery, but patients who develop this complication do not show improvements in the health-related quality-of-life measurements.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.