A Case of Epidural Hematoma after Lumbar Spine Surgery in a Hemophilia B Carrier.

Abstract

Hemophilia B is a quantitative or qualitative factor IX anomaly that manifests as an X-linked recessive inheritance pattern in which females are carriers. Postoperative epidural hematoma emerges as a typical complication in spinal surgery, although its incidence is infrequent. No documentation of postoperative epidural hematoma in carriers of hemophilia B exists. A 64-year-old female patient presented with progressive pain and muscle weakness in both lower limbs. Despite a history of childbirth and prior colorectal cancer surgery, the patient displayed no abnormal bleeding tendencies. Subsequently undergoing decompression surgery for lumbar spinal canal stenosis, the patient experienced paralysis and pain in both legs within 5 hours postoperatively. A magnetic resonance imaging scan revealed severe spinal canal compression attributed to a postoperative epidural hematoma, prompting emergency decompression surgery that ameliorated symptoms. The application of gelatin-thrombin matrix sealants (GTMS) facilitated hematoma removal, resulting in an uneventful recovery. In a postoperative interview, it was revealed that her grandson was undergoing treatment for hemophilia B. Additionally, she exhibited diminished factor IX levels and was diagnosed as a hemophilia B carrier. A definitive preoperative diagnosis of the carrier status is imperative. In instances where surgical intervention is warranted, the implementation of factor IX replacement and intraoperative hemostasis with GTMS is promising for potentially averting the onset of postoperative epidural hematoma.