Catheter-assisted evacuation through limited laminectomy for traumatic long-segment spinal epidural hematoma in ankylosing spondylitis: a technical note and two case reports

BACKGROUND: Patients with ankylosing spondylitis (AS) are prone to unstable spinal fractures with long-segment spinal epidural hematoma (LSEH). Conventional multilevel laminectomy can achieve complete decompression but may disrupt the posterior tension complex. In this article, we describe a catheter-assisted technique for evacuating LSEH through a limited laminectomy window. METHODS: Two AS patients with traumatic cervicothoracic LSEH underwent emergency posterior stabilization followed by limited laminectomy. A 15 Fr silicone catheter with a distal side-hole was advanced epidurally along the hematoma through the laminectomy window. We applied alternating negative-pressure suction and intermittent saline irrigation until free backflow was achieved and dural decompression was confirmed. RESULTS: Complete radiographic decompression was obtained in both cases and their neurological recovery was substantial. Case 1 improved from Japanese Orthopaedic Association (JOA) score 3/17 and American Spinal Injury Association (ASIA) classification B preoperatively to JOA 16/17 and ASIA E at 6 months post operation, regaining independent ambulation. Case 2, presenting with JOA 0/17 and ASIA A pre-operation, improved to JOA 9/17 and ASIA C at final follow-up, with a recovery of deep sensation and partial motor function. CONCLUSION: Catheter-assisted evacuation via limited laminectomy represents a feasible approach for LSEH in AS patients. This technique facilitates effective decompression while minimizing damage to posterior spinal structures.