Delayed Hematoma Evacuation After Spinal Stenosis Surgery in Korea

Case Overview

A woman in her sixties sought treatment at a university hospital for severe spinal stenosis affecting the lower thoracic spine and several lumbar levels. Her physicians recommended posterior decompression to widen the narrowed nerve canal together with spinal fusion, and she underwent the operation.

Within days of surgery, she began to lose strength in her right leg and had difficulty walking. She also developed difficulty urinating and passing stool. Her symptoms did not improve, her inflammatory markers rose, and she developed a fever. Only after a multidisciplinary consultation recommended further imaging was an MRI performed, twelve days after the operation. It showed a hematoma — a collection of clotted blood — compressing the nerves at the surgical site. The emergency operation to remove the hematoma took place more than twenty-four hours after the MRI.

Taeshin Law Firm represented the patient, her spouse, and her children in the damages claim at first instance and on appeal. The appellate court ultimately issued a decision in lieu of mediation ordering the hospital to pay 158 million won.

Background

Spinal stenosis is a narrowing of the spinal canal, the passage through which the spinal cord and nerve roots travel. When the narrowing becomes severe, it can cause back and leg pain, numbness, and weakness that persist despite conservative treatment. For multilevel disease, surgeons may recommend posterior decompression together with fusion to relieve pressure on the nerves and stabilize the spine.

The client's operation was performed at a university hospital. In the days that followed, the neurological picture changed. Weakness in the right leg made walking difficult, and she lost normal control of urination and defecation. Over roughly the next ten days the symptoms persisted rather than resolving, while her inflammatory markers climbed and she developed a fever.

Imaging was not repeated during that period. After another department recommended re-evaluation with imaging, an MRI was finally obtained twelve days after surgery. It revealed a hematoma at the operative site pressing on the spinal nerves. Even after that finding, the hematoma was not evacuated until more than twenty-four hours had passed.

The client underwent prolonged inpatient rehabilitation, but she was left with perianal sensory loss, voiding dysfunction, and reduced sensation and strength in her legs. She and her family brought a claim for damages against the hospital, and Taeshin Law Firm represented them in both the first-instance and appellate proceedings.

Medical Issue

A postoperative spinal hematoma is a recognized complication of spinal surgery. Blood can collect in the epidural space and compress the spinal cord or the nerve roots, producing new or worsening leg weakness, sensory loss, and bladder or bowel dysfunction. Those findings are regarded as red flags: the longer the compression continues, the greater the risk that neurological damage becomes permanent. Prompt imaging and, where a compressive collection is identified, urgent decompression are central to limiting that risk.

The medical question in this case was therefore not only how the operation was performed, but how the hospital responded once the client's postoperative symptoms pointed to a possible hematoma.

Key Legal Issues

Four issues shaped the litigation.

First, the claimant alleged that the operation itself was performed negligently, injuring or compressing the nerves during decompression or fusion.

Second, and more significantly, the claim focused on postoperative care. The client argued that her symptoms called for prompt MRI, CT, or electromyographic testing, and that the failure to investigate and to remove the hematoma in time allowed her neurological injury to worsen.

Third, the claim raised informed consent, questioning whether the risks of postoperative hematoma and neurological complications had been adequately explained before surgery.

Fourth, the parties disputed the scope of damages. Because nursing care made up the largest part of the loss, the case turned on the degree of lost earning capacity and on how much care the client would need in the future.

The hospital maintained that the surgery had not caused the nerve injury. It argued that a patient with intraoperative nerve damage would have experienced severe pain, yet pain medication was administered only much later. It also relied on a postoperative X-ray that did not show nerve compression, and contended that a hematoma was therefore difficult to suspect. The hospital further argued that delays in obtaining an MRI reading, preparing the patient for fasting, and securing an operating room made the timing of the evacuation unavoidable.

Taeshin's Approach

Taeshin Law Firm built the claim around the interval between surgery and treatment. The client had reported symptoms consistent with a compressive hematoma, yet the medical team did not pursue the imaging and testing needed to confirm or exclude that diagnosis, and the evacuation was correspondingly delayed. The firm argued that this failure to act on recognizable warning signs fell below the applicable standard of care and caused the worsening of her condition.

The firm also advanced surgical negligence and breach of the duty to obtain informed consent as additional grounds, so that the claim did not depend on a single theory.

On damages, the firm relied on the physical appraisal and calculated each head of loss: lost earning capacity, past and future nursing care, rehabilitation costs, future treatment including testing for neurogenic bladder dysfunction, and the cost of assistive devices.

On appeal, when the court indicated it would hear an expert advisory opinion, the firm requested that a neurosurgeon specializing in spinal disorders be designated and that specialists from unrelated fields be excluded, so that the medical questions would be assessed by a physician with relevant expertise.

Outcome

The first-instance court did not find negligence in the performance of the surgery itself, and it did not uphold the informed-consent claim. It did, however, find the hospital negligent in its postoperative management. The court held that once the client's symptoms raised the possibility of a hematoma, the hospital should have pursued additional testing without delay and taken appropriate action. It pointed to the twelve-day interval before the MRI, the further delay of more than twenty-four hours before the hematoma was removed, and the fact that the client's pain complaints increased after her pain medication was discontinued.

On damages, the court treated the bilateral leg weakness and voiding dysfunction as permanent impairments and assessed a 39 percent loss of earning capacity.

Both sides appealed. The appellate court issued a decision in lieu of mediation ordering the hospital to pay 158 million won.

In Korean civil procedure, a court may issue a decision in lieu of mediation to resolve a case on terms it considers appropriate. If neither party objects within the statutory period, the decision becomes final and has effect comparable to a settlement, bringing the dispute to an end without a further judgment.

What This Case Shows

This case illustrates that liability in a Korean medical malpractice claim can rest on postoperative monitoring even where the operation itself is found to have been performed properly. The decisive facts were the clinical timeline: which symptoms appeared, when they were reported, how the hospital responded, and how long the diagnostic and surgical steps took.

It also shows why detailed nursing and medical records matter. The claim was built by reconstructing that timeline and comparing it with the standard of care for a suspected postoperative hematoma.

Finally, the case reflects how damages are assessed in serious Korean medical malpractice litigation. Nursing care and future treatment can form a substantial part of the award, and the degree of permanent impairment must be supported by a physical appraisal. Where a first-instance court accepts liability but the parties dispute the amount, an appeal can still lead to a court-mediated resolution.