Postoperative Spinal Subdural Lesions Following Lumbar Spine Surgery: Prevalence and Risk Factors

Abstract

Study DesignRetrospective case–control studyPurposeTo clarify the prevalence and risk factors for spinal subdural lesions (SSDLs) following lumbar spine surgery.Overview of LiteratureBecause SSDLs, including arachnoid cyst and subdural hematoma, that develop following spinal surgery are seldom symptomatic and require reoperation, there are few reports on these pathologies. No study has addressed the prevalence and risk factors for SSDLs following lumbar spine surgery.MethodsWe conducted a retrospective analysis of the magnetic resonance (MR) images and medical records of 410 patients who underwent lumbar decompression surgery with or without instrumented fusion for degenerative disorders. SSDLs were classified into three grades: grade 0, no obvious lesion; grade 1, cystic lesion; and grade 2, lesions other than a cyst. Grading was based on the examination of preoperative and postoperative MR images. The prevalence of SSDLs per grade was calculated and risk factors were evaluated using multivariate logistic regression analysis.ResultsPostoperative SSDLs were identified in 123 patients (30.0%), with 50 (12.2%) and 73 (17.8%) patients being classified with grade 1 and 2 SSDLs, respectively. Among these, one patient was symptomatic, requiring hematoma evacuation because of the development of incomplete paraplegia. Bilateral partial laminectomy was a significantly independent risk factor for SSDLs (odds ratio, 1.52; 95% confidence interval, 1.20–1.92; p<0.001). In contrast, a unilateral partial laminectomy was a protective factor (odds ratio, 0.11; 95% confidence interval, 0.03–0.46; p=0.002).ConclusionsThe prevalence rate of grade 1 SSDLs was 30%, with no associated clinical symptoms observed in all but one patient. Bilateral partial laminectomy increases the risk for SSDLs, whereas unilateral partial laminectomy is a protective factor.

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“…ey identified SSDLs in 30% of the 410 cases of lumbar spine surgery. [7] Mattei et al reported a case of acute SSDH after vertebroplasty. [6] de Beer et al showed that spontaneous SSDHs were predominantly located in the thoracic spine and correlated with acute paraparesis/ paraplegia; over 40% was caused by a coagulation defect, most frequently due to Coumadin.…”

An Acute Spinal Intradural Hematoma after an Extraforaminal Wiltse Approach: A Case Report and Review of the Literature

“…A postoperative sSDH is a very rare complication in particular after an extraforaminal herniation resection with a Wiltse approach. 10,11 In most cases, an intradural hematoma is associated with trauma, vascular malformations, tumors, traumatic lumbar puncture, or anticoagulation therapy. 7,12,13 We presented a case of a 58-year-old woman with an intradural hematoma after resection of a left-sided extraforaminal disk herniation at L5/S1 by an extraforaminal Wiltse approach.…”

Spinal subdural hematoma and ankylosing spondylitis: case report and review of literature

“…While epidural hematomas are a relatively common cause of symptoms after trauma or surgery [2], subdural hematomas, by contrast, are very rare. Acute spinal subdural hematomas have been reported following lumbar punctures [3], spinal [4] and cranial surgery [5], and trauma [6], with spontaneous hemorrhages relatively uncommon. The few spontaneous hemorrhages reported in the literature include patients with bleeding disorders, those on anticoagulant therapy [1], and underlying lesions, such as vascular malformations or tumors [7].…”