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Case Reports in Orthopedics
Volume 2015, Article ID 536592, 3 pages
http://dx.doi.org/10.1155/2015/536592
Case Report

Recurrent Postoperative Spinal Epidural Hematoma in a Patient with Protein S Deficiency

Department of Orthopaedic Surgery, Musashino Red Cross Hospital, 1-26-1 Kyonan-cho, Musashino-shi, Tokyo 1800023, Japan

Received 22 April 2015; Revised 10 June 2015; Accepted 21 June 2015

Academic Editor: Hitesh N. Modi

Copyright © 2015 Masato Anno et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A 71-year-old man underwent cervical laminectomy and developed two symptomatic epidural hematomas during the acute postoperative period. On both occasions, drain obstruction was the predominant cause. Congenital Protein S deficiency was diagnosed postoperatively. Protein S is a vitamin K-dependent natural anticoagulant and is essential for inhibiting thrombosis in microcirculation. We assume that Protein S deficiency followed by perioperative bed-rest and surgical invasiveness led to severe hypercoagulability and subsequent drain obstruction. The present findings suggest that both bleeding disorders and hypercoagulability are risk factors for postoperative symptomatic epidural hematoma.