Introduction: Compressive epidural haematomas occurring following
spine surgery are very rare but can potentially lead to irreversible
damage. The evacuation of the haematoma as an emergency
procedure remains the only effective treatment providing though
alerting signs are detected on time. Few studies exist on this subject
probably due to its rarity. The etiological factors as well as the place
of imaging studies prior to urgent haematoma evacuation remain
controversial. Two cases of delayed post-operative compressive
epidural haematomas following lumbar-spine surgery were detected
in our unit between April 2003 and January 2009. In both cases new
onset of pain, aggravation of existing neurological deficit or
development of new deficit along with worsening of pre-existing
walking difficulties were noted. Emergency computer tomography (CT)
could not exclude compression in both cases due to important
artefacts. Emergency surgery was performed confirming the presence
of haematoma in both cases and leading to a complete neurological
recovery following its evacuation. As only risk factors common to both
cases we identified drain removal and resuming of thromboprophylaxis.
Conclusion: Obstacles in early detection of post-operative
compressive epidural haematomas occurring following spine surgery
are patients presenting with multiple complaints as well as shift work
pattern of staff who might not always be trained in detecting early
changes in neurological status. We therefore established a checklist
for post-operative neurological observations to be carried out on spine
surgery patients during the postoperative period. We describe our
adopted attitude considering the etiological factors observed in our
unit. Further studies including in a multi centre setting would be
necessary in order to ascertain our observations.