Received: 19 March 2003 Revised: 16 May 2003 Accepted: 19 May 2003 Published online: 24 July 2003 © ISS 2003 Abstract A 78-year-old man devel- oped a large subdural hematoma ex- tending from T12 to L3 levels fol- lowing L3 laminectomy and L3–5 posterior spinal fusion. He had asso- ciated neurological signs and symp- toms. MR imaging showed typical signal characteristics of a subacute intraspinal subdural hematoma. Per- cutaneous drainage was successfully performed under CT guidance by in- serting a Tuohy needle through the L3 laminectomy defect. The catheter packaged with the Tuohy needle was inserted cranially into the hematoma and 30 ml of blood was aspirated. Follow-up MR imaging confirmed resolution of the hematoma and the patient made a rapid recovery. Keywords Spinal subdural hematoma · Tuohy needle · Percutaneous drainage · Computed tomography · Magnetic resonance imaging Skeletal Radiol (2003) 32:603–607 DOI 10.1007/s00256-003-0666-5 CASE REPORT Harvey E. L. Teo Wilfred C. G. Peh Seang Beng Tan Percutaneous drainage of a postoperative intraspinal hematoma using a Tuohy needle Introduction Intraspinal hematomas are rare but may result in cord compression with serious neurological sequelae. The treatment of choice is surgical decompression. We report a case in which an intraspinal subdural hematoma occur- ring after lumbar spinal surgery was successfully treated with percutaneous drainage using a Tuohy needle. Case report A 78-year-old man was referred to our institution with a complaint of back pain of 2 years duration. The pain had been increasing in severity over the previous few months and was radiating down the patient’s left leg. The patient had had L4–5 laminectomies and L4- S1 fusion 10 years prior to the current consultation. He had a past medical history of triple-vessel coronary bypass, transurethral prostatectomy and retinal detachment, and was currently on medi- cation for hypertension. Radiographs of the lower lumbosacral spine showed L4–5 spondylolisthesis and L3–4 retrolisthesis. L3 laminectomy and decompression of the L4 and L5 nerve roots were performed. Stabilization of the posterior elements with pedicular screws at the L3–5 levels and bone grafting were also performed (Fig. 1). On the third postoperative day, the patient complained of weakness of both legs, which persisted and worsened over the next few days. On the ninth postoperative day, magnetic resonance (MR) imaging was performed. This showed a fluid collection in the subdural space, extending from lower T12 to upper L3 levels (Fig. 2). This collection communicated with small epidural and larger posterior extraspinal soft tissue collections through the L3 laminectomy defect. The collection was high in signal intensity on both T1- and T2-weighted MR images. Diagnosis of a subacute intraspinal subdural hematoma with a small epidural and large ex- traspinal component was made. Percutaneous drainage was performed with the patient in a prone position under computed tomography (CT) fluoroscopic guidance (Fig. 3). After infiltration of local anesthetic, an 18 G Tuohy needle was inserted into the subdural space via the left L3 laminectomy defect. After initial aspiration of stale blood, the H. E. L. Teo · W. C. G. Peh Department of Diagnostic Radiology, KK Women’s and Children’s Hospital, Singapore S. B. Tan Department of Orthopaedic Surgery, Singapore General Hospital, Singapore W. C. G. Peh ( ✉ ) Programme Office, Singapore Health Services, 7 Hospital Drive #02–09, 169611, Singapore e-mail: wilfred.peh@singhealth.com.sg Tel.: +65-6327-5843 Fax: +65-6327-8803