Delayed Cervical Epidural Hemorrhage Associated with Silastic Dural Implant: Case Report

OBJECTIVE AND IMPORTANCE: This is the first report of delayed cervical epidural hemorrhage caused by an onlay silastic graft placed over the dura after laminectomy. There are several reports of intracranial hemorrhage associated with silastic implants in the literature. CLINICAL PRESENTATION: A 49-year-old woman suddenly developed severe neck pain and quadriplegia during sexual intercourse. A C5-C7 laminectomy had been performed 17 years earlier for cervical stenosis. INTERVENTION: Magnetic resonance imaging showed an epidural mass compressing the cord at the level of the previous laminectomy. Laminectomy was performed within 5 hours of symptom onset. Postoperatively, the patient regained leg strength. After 2 months of physical therapy, she had minimal residual leg rigidity and returned to work. TECHNIQUE: At surgery, the cervical cord was compressed by a solid fibrous scar surrounding a silastic onlay graft and the dura. An epidural hematoma was beneath the silastic implant. The dense scar tissue, hematoma, and silastic implant were removed. CONCLUSION: Bleeding associated with silastic sheets starts with movement of this nonadherent implant. The movement disrupts the underlying fine vessels on the surface of an encasing connective tissue membrane. Overgrowth of this membrane can cause mass effect and simulate a tumor, even without associated bleeding, within weeks. Delayed hemorrhage is more common. We recommend removal of these implants electively, especially if a thick membrane surrounding the dura is detected with postcontrast-enhanced magnetic resonance imaging.