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Multilevel Spinal Combined Subdural/Subarachnoid Hemorrhage Resulting in Paraplegia: An Unusual Complication of Kyphoplasty.

BACKGROUND:  Paraplegia due to spinal combined subdural/subarachnoid hemorrhage is an extremely rare complication following percutaneous spinal augmentation procedures.

METHODS:  A 63-year-old male patient presented with severe neurologic decline (paraplegia with sensory and autonomic dysfunction) resulting from a multilevel spinal subarachnoid hemorrhage shortly after bilateral kyphoplasty.

RESULTS:  Reduction of intrathecal pressure via multiple dural and arachnoidal incisions and removal of the hematoma resulted in a good neurologic recovery with surgical decompression even though evacuation was performed with a significant delay after the onset of neurologic worsening.

CONCLUSION:  Spinal augmentation procedures should only be performed in a setting where management of complications can also be diagnosed and performed. Robot-assisted or navigation-assisted pedicle perforation should be considered because complications can be reduced significantly.

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