Scrotal pain after lumbar fusion surgery

Rationale: Postoperative spinal epidural hematoma, a rare complication of spinal surgery, can result in serious morbidity if not surgically decompressed appropriately. Patient concerns: We report a case of scrotal and urethral pain due to an L5–S1 epidural hematoma that occurred after L4–5 surgery. The patient had no new sensory or motor abnormalities after surgery. Because he voided normally after surgery, it was initially thought that the pain was due to an injury caused by insertion of the Foley catheter. However, no abnormalities were observed after urological examination. Diagnoses: Subsequently, an epidural hematoma at the distal level was discovered on magnetic resonance imaging. Interventions: The patient underwent urgent surgical evacuation of the hematoma via partial laminectomy. Outcomes: Scrotal and urethral pain improved after surgical decompression, indicating an atypical presentation of spinal epidural hematoma. Lessons: This case illustrates the need to differentiate neurogenic pain in cases where urethral and scrotal pain were observed after lumbar surgery in the absence of urological abnormalities. Follow-up magnetic resonance imaging after surgery is recommended if a patient complains of any abnormal symptoms, as prompt diagnosis may improve the quality of life of the affected patient.