{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T02:17:09Z","timestamp":1788315429133,"version":"build-2803163510"},"reference-count":34,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Delayed postoperative spinal epidural hematoma (DPSEH) is a rare but serious complication of cervical open\u2010door laminoplasty, which occurs more than 3\u2009days after the procedure. Although multi\u2010level surgery, coagulopathy, and hypertension are known risk factors, suture\u2010related mechanisms have rarely been identified as the main cause.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>We present two cases of symptomatic DPSEH occurring on the seventh postoperative day following posterior cervical open\u2010door laminoplasty. Following initial recovery, both patients experienced acute neurological deterioration. An emergency MRI revealed hematomas within the paraspinal muscles compressing the spinal cord. Intraoperative exploration identified a huge hematoma within the posterior cervical muscles and active bleeding from muscle tissue, with no injury to the epidural venous plexus. Interestingly, absorbable barbed sutures were used for muscular and fascial closure in both procedures. The patients exhibited significant neurological recovery following emergency hematoma evacuation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These cases suggest that suture\u2010related complications, specifically knot loosening, suture migration, or barb\u2010induced tissue cutting, may contribute to intramuscular bleeding and subsequent DPSEH. However, given the limited evidence from a two\u2010case report, this association should be interpreted as a clinical alert rather than definitive proof of causality. Surgeons should maintain a high index of suspicion for DPSEH in patients who experience sudden postoperative pain or neurological decline. They should also consider suture choice as a potentially modifiable risk factor.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/os.70400","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T23:50:46Z","timestamp":1785973846000},"page":"2003-2012","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Suture\u2010Related Delayed Epidural Hematoma Following Cervical Open\u2010Door Laminoplasty: A Report of Two Cases and Literature Review"],"prefix":"10.1111","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-7783-0693","authenticated-orcid":false,"given":"Xiaoxuan","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Orthopedics, Orthopedic Research Institute West China Hospital, Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1288-8470","authenticated-orcid":false,"given":"Can","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Orthopedic Research Institute West China Hospital, Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junbo","family":"He","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine Center and Institute of Rehabilitation Medicine West China Hospital, Sichuan University  Chengdu Sichuan China"},{"name":"Key Laboratory of Rehabilitation Medicine in Sichuan Province  Chengdu Sichuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Orthopedic Research Institute West China Hospital, Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kangkang","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Orthopedic Research Institute West China Hospital, Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Orthopedic Research Institute West China Hospital, Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1823-5457","authenticated-orcid":false,"given":"Chen","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Orthopedic Research Institute West China Hospital, Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"e_1_2_13_2_1","first-page":"296","article-title":"Application of Posterior Cervical Surgery in Treatment of Cervical Spondylotic Myelopathy","volume":"15","author":"Xu C. 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