A dressing that soaks through after spine surgery can mean bleeding, a hematoma, a spinal fluid leak or an early infection. The nurse must judge the drainage, check the legs for new weakness and alert the surgeon quickly, because a growing hematoma can compress the spinal cord or nerves.
Key symptoms
- Dressing soaked with blood or with clear or pink fluid
- Increasing back pain or pressure at the incision
- New numbness, weakness or trouble urinating
- Headache when sitting up that eases lying flat, with a fluid leak
What you find on exam
- Mark the edge of the drainage and note color, amount and time
- Neurovascular check of both legs: strength, sensation and pulses
- Swelling or firmness around the incision
- Drain output and vital signs
Tests
- Hemoglobin, platelets and coagulation tests
- Beta-2 transferrin on clear drainage to confirm spinal fluid
- Urgent MRI if there is a new neurologic deficit
- Wound culture if there is pus or other signs of infection
Treatment basics
- Reinforce the dressing, do not remove it unless ordered, and notify the surgeon
- Keep the patient flat and log roll if a spinal fluid leak is suspected
- Hold anticoagulants and correct clotting problems as ordered
- Emergency surgery to drain a hematoma compressing the cord
- Antibiotics and wound washout for infection
Red flags
- New leg weakness, numbness or loss of bladder control
- Rapid bleeding with falling blood pressure
- Fever with foul or cloudy drainage
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Sources: NCCPA PANCE Content Blueprint; NCSBN 2026 NCLEX-RN Test Plan; Open RN, Nursing Skills 2e (Chippewa Valley Technical College). Written by Making Synapses. Making Synapses is not affiliated with these organizations.