{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T17:07:57Z","timestamp":1789578477643,"version":"build-2803163510"},"reference-count":20,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"21","license":[{"start":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:00:00Z","timestamp":1779667200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,5,25]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Postoperative spinal epidural hematoma (SEH) is an uncommon but serious complication after lumbar endoscopic surgery, with an incidence of 0.1%\u20130.2%. Although percutaneous endoscopic lumbar discectomy (PELD) minimizes tissue disruption, SEH may still occur, particularly in patients with hematological disorders. Essential thrombocythemia (ET) presents a hemostatic paradox of simultaneous bleeding tendency and hypercoagulability, increasing postoperative hematoma risk. Massive multilevel SEH after PELD is rare.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A patient developed severe left leg pain immediately after PELD. A second endoscopic reexploration was performed without MRI, removing clotted blood, but symptoms rapidly recurred, prompting open decompression at L2\u20134. MRI performed afterward revealed a massive posterior epidural hematoma from L1 to S1, similar to previously reported multilevel SEHs. Rapid hematoma reaccumulation was attributed to uncontrolled ET following discontinuation of cytoreductive therapy. Neurological symptoms stabilized only after the resumption of hydroxyurea and anagrelide, with MRI showing near-complete resolution.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>This case illustrates the hemostatic paradox of ET in spine surgery, in which excessive bleeding and rapid clot formation coexist. When hematological instability drives SEH, repeated decompression may fail, and hematological correction becomes essential. Surgeons should recognize the limitations of endoscopic hemostasis and consider early hematological optimization when postoperative symptoms recur.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE25962\">https:\/\/thejns.org\/doi\/10.3171\/CASE25962<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25962","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T14:52:32Z","timestamp":1779288752000},"source":"Crossref","is-referenced-by-count":1,"title":["Recurrent multilevel postoperative spinal epidural hematoma in a patient with essential thrombocythemia: failure of repeated decompression and hematological correction. Illustrative case"],"prefix":"10.3171","volume":"11","author":[{"given":"Jen-Chieh","family":"Lai","sequence":"first","affiliation":[{"name":"Department of Orthopedics, Taichung Armed Forces General Hospital, Taichung"},{"name":"Department of Life Sciences, National Chung Hsing University, Taichung"},{"name":"Department of Medicine, National Defense Medical University, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"9","key":"bib1","series-title":"J Bone Joint Surg Br","first-page":"1248","article-title":"Analysis of the risk factors for the development of post-operative spinal epidural haematoma","volume":"87","author":"Awad","year":"2005","unstructured":"Awad JNKebaish KMDonigan JCohen DBKostuik JP.Analysis of the risk factors for the development of post-operative spinal epidural haematoma. J Bone Joint Surg Br. 2005;87(9):1248-1252. doi:10.1302\/0301-620X.87B9.16518"},{"issue":"1","key":"bib2","series-title":"BMC Musculoskelet Disord","first-page":"324","article-title":"Incidence and risk factors of spinal epidural hemorrhage after spine surgery: a cross-sectional retrospective analysis of a national database","volume":"21","author":"Park","year":"2020","unstructured":"Park JHPark SChoi SA.Incidence and risk factors of spinal epidural hemorrhage after spine surgery: a cross-sectional retrospective analysis of a national database. BMC Musculoskelet Disord. 2020;21(1):324. doi:10.1186\/s12891-020-03337-8"},{"issue":"3","key":"bib3","series-title":"Surg Neurol","first-page":"253","article-title":"Spontaneous spinal epidural hematoma: analysis of 23 cases","volume":"69","author":"Liu","year":"2008","unstructured":"Liu ZJiao QXu JWang XLi SYou C.Spontaneous spinal epidural hematoma: analysis of 23 cases. Surg Neurol. 2008;69(3):253-260. doi:10.1016\/j.surneu.2007.02.019"},{"key":"bib4","series-title":"World Neurosurg","first-page":"e324","article-title":"Risk factors of postoperative spinal epidural hematoma after biportal endoscopic spinal surgery","volume":"129","author":"Kim","year":"2019","unstructured":"Kim JEChoi DJKim MCPark EJ.Risk factors of postoperative spinal epidural hematoma after biportal endoscopic spinal surgery. World Neurosurg. 2019;129:e324-e329. doi:10.1016\/j.wneu.2019.05.141"},{"issue":"13","key":"bib5","series-title":"Blood","first-page":"2176","article-title":"Myeloproliferative neoplasms and thrombosis","volume":"122","author":"Barbui","year":"2013","unstructured":"Barbui TFinazzi GFalanga A.Myeloproliferative neoplasms and thrombosis. Blood. 2013;122(13):2176-2184. doi:10.1182\/blood-2013-03-460154"},{"issue":"12","key":"bib6","series-title":"Am J Hematol","first-page":"1599","article-title":"Polycythemia vera and essential thrombocythemia: 2021 update on diagnosis, risk-stratification and management","volume":"95","author":"Tefferi","year":"2020","unstructured":"Tefferi ABarbui T.Polycythemia vera and essential thrombocythemia: 2021 update on diagnosis, risk-stratification and management. Am J Hematol. 2020;95(12):1599-1613. doi:10.1002\/ajh.26008"},{"issue":"17","key":"bib7","series-title":"Blood","first-page":"1889","article-title":"Ruxolitinib vs best available therapy for ET intolerant or resistant to hydroxycarbamide","volume":"130","author":"Harrison","year":"2017","unstructured":"Harrison CNMead AJPanchal ARuxolitinib vs best available therapy for ET intolerant or resistant to hydroxycarbamide. 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