Background: One-Hole Split Endoscopic (OSE) discectomy is an emerging minimally invasive technique for lumbar degenerative disease. While OSE offers advantages such as reduced tissue dissection, it is not exempt from complications inherent to spinal surgery. Postoperative spinal epidural hematoma (POSEH), though rare, is a serious complication that can lead to significant neurological deterioration if not managed promptly. Although POSEH has been documented with other endoscopic lumbar procedures, no cases of delayed POSEH (DPOSEH) following OSE have been reported in the literature to date. Case presentation: A 69-year-old male underwent OSE discectomy at L4–L5 for symptomatic disc herniation. The initial postoperative course was uneventful, with improvement in radicular symptoms and intact neurological function. However, on postoperative day 5, he developed acute back pain, bilateral lower limb weakness, saddle anesthesia, and fecal incontinence. Emergency MRI confirmed a compressive epidural hematoma extending from L4 to L5. During the urgent surgical evacuation, multiple organized blood clots of varying sizes were identified and removed. Through postoperative rehabilitation therapy, the patient's left lower limb muscle strength gradually improved, though bowel and bladder dysfunction persisted. Conclusions: The present case highlights that, despite the absence of prior literature on this complication in OSE, the risk of symptomatic epidural hematoma exists similarly to other endoscopic spinal techniques. Early recognition, prompt imaging, and immediate surgical intervention are critical to optimizing neurological recovery. Surgeons should maintain a high index of suspicion for POSEH in OSE patients presenting with acute neurological decline, even beyond the typical 72-h postoperative window.

Objective: Acute cerebral vasospasm (aCVS) is a severe complication commonly occurring after subarachnoid hemorrhage, leading to significant morbidity and mortality despite current therapeutic interventions. This study aims to elucidate the potential therapeutic mechanisms of Ligusticum wallichii (L. wallichii) against aCVS through an integrated approach of bioinformatics, meta-analysis, and network pharmacology. Materials and Methods: Studies related to L. wallichii and aCVS were systematically retrieved from public databases, followed by a meta-analysis on the effectiveness of L. wallichii extracts in treating or preventing aCVS. Major components were identified through the Traditional Chinese Medicine (TCM) Systems Pharmacology database, with their three-dimensional structures obtained from PubChem. Target predictions on human proteins were performed using PharmMapper, and these were complemented by ribonucleic acid sequencing differentially expressed genes (DEGs) analysis of the dataset GSE37924. An intersection analysis was performed to explore the overlap between predicted targets. Protein–protein interaction, Gene Ontology, and Kyoto Encyclopedia of Genes and Genomes enrichment analyses were conducted, followed by the construction of a pharmacological network using Cytoscape. The key components and their predicted targets were further analyzed and validated through molecular docking simulations. Results: The meta-analysis revealed that tetramethylpyrazine, a key component of L. wallichii extracts, showed significant potential in alleviating and preventing symptoms of aCVS. Key components, such as beta-sitosterol, folic acid, mandenol, myricanone, perlolyrine, senkyunone, and wallichilide, were linked to 414 potential target proteins. From the GSE37924 dataset, 22 candidate target proteins were identified, with folic acid, myricanone, and perlolyrine playing central roles in the network, potentially targeting Adenosylmethionine Decarboxylase 1, Adenosine diphosphate-ribosylation factor 1, Casein Kinase 1 Gamma 2, among others, to mitigate aCVS. Conclusions: L. wallichii and its key components demonstrate potential therapeutic effects in treating aCVS. These findings provide scientific support for the potential therapeutic application of L. wallichii in aCVS treatment, demonstrating the direct value of TCM in modern medical applications.