Spinal Epidural Haematoma After Cervical Spine Surgery — A Rare but Important Complication
Spinal epidural haematoma after ACDF occurs in less than 1% of patients. How to recognise it, who is at risk and why post-operative monitoring matters.
ACDF — anterior cervical discectomy and fusion — is one of the most commonly performed procedures in cervical spine surgery. It is used to treat cervical disc herniation, spinal canal stenosis and nerve root compression. The procedure is effective and safe, but like any operation it carries a degree of risk.
One of the rarer yet potentially serious complications is spinal epidural haematoma (SEH). The latest systematic review and meta-analysis, published in 2025, covered 3,246 patients and 28 SEH cases, putting the overall incidence at 0.84%.
How It Presents
Symptoms of a spinal epidural haematoma may appear within the first 24 hours after surgery, but delayed presentations — even several days post-operatively — have been reported. The most common warning signs are: increasing dyspnoea, sudden limb weakness (paresis) or, in more severe cases, quadriplegia.
Dyspnoea is a particularly important symptom because it can be mistaken for other causes — an anaesthesia reaction, soft-tissue swelling of the neck or post-operative anxiety. That is why any breathing difficulty after cervical spine surgery warrants immediate evaluation.
Who Is at Risk
The literature review points to several factors that may increase the risk: coagulation disorders, anticoagulant medication and more extensive multi-level procedures. Unfortunately, because the complication is rare, data are limited — the authors stress the need for large-scale prospective studies.
Treatment
Management depends on symptom severity and haematoma size. In most reported cases, reoperation was necessary — surgical decompression to evacuate the haematoma and relieve pressure on the spinal cord. Some milder cases were managed conservatively with close monitoring.
The critical point is that rapid intervention significantly improves outcome. The shorter the duration of cord compression, the greater the chance of full neurological recovery.
What This Means for the Patient
If you have an ACDF procedure planned, this information should not cause alarm — the complication affects fewer than one in a hundred patients. It should, however, help you understand why post-operative observation is so important and why the medical team closely monitors neurological status in the first hours and days after surgery.
At Allenort Spine & Brain, every patient after spinal surgery goes through a standardised monitoring protocol — assessment of muscle strength, sensation and respiratory function. This allows us to detect any complications at the earliest stage, when intervention is most effective.
Source: Incidence of Spinal Epidural Hematoma After Anterior Cervical Decompression and Fusion: Systematic Review, Meta-Analysis, and Case Report. PubMed PMID: 40915628 (2025).
