Risk Factors for Spinal Epidural Hematoma After Spinal Surgery

Kou, Jiantao; Fischgrund, Jeffrey S.; Biddinger, A.; Herkowitz, Harry N.

doi:10.1097/00007632-200208010-00016

Cited by 280 publications

(258 citation statements)

References 20 publications

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“…Postoperative epidural hematoma as an early complication after decompression in lumbar stenosis occurs with a prevalence of 0.1-0.2% [1][2][3][4]. Magnetic resonance imaging (MRI) is recommended in patients with postoperative increasing pain and new neurological symptoms to rule out hematoma.…”

Section: Introductionmentioning

confidence: 99%

Early postoperative MRI in detecting hematoma and dural compression after lumbar spinal decompression: prospective study of asymptomatic patients in comparison to patients requiring surgical revision

et al. 2010

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Early postoperative MRI after spinal surgery is difficult to interpret because of confounding postoperative mass effects and frequent occurrence of epidural hematomas. Purpose of this prospective study is to evaluate prevalence, extent and significance of hematoma in the first postoperative week in asymptomatic patients after decompression for lumbar stenosis and to determine the degree of clinically significant dura compression by comparing with the patients with postoperative symptoms. MRI was performed in 30 asymptomatic patients (47 levels) in the first week after lumbar spine decompression for degenerative stenosis. Eleven patients requiring surgical revision (16 levels) for symptomatic early postoperative hematoma were used for comparison. In both groups the cross-sectional area of the maximum dural compression (bony stenosis and dural sac expansion) was measured preoperatively and postoperatively by an experienced radiologist. Epidural hematoma was seen in 42.5% in asymptomatic patients (20/47 levels). The median area of postoperative hematoma at the operated level was 176 mm 2 in asymptomatic patients and 365 mm 2 in symptomatic patients. The median cross-sectional area of the dural sac at the operated level was 128.5 and 0 mm 2 in asymptomatic and symptomatic patients, respectively, at the site of maximal compression. In the symptomatic group 75% of the patients had a maximal postoperative dural sac area of 58.5 mm 2 or less, whereas in the asymptomatic group 75% of patients with epidural hematoma had an area of 75 mm 2 or more. The size of hematoma and the degree of dural sac compression were significantly larger in patients with symptoms needing surgical revision. Dural sac area of less than 75 mm 2 in early postoperative MRI was found to be the threshold for clinical significance.

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Section: Introductionmentioning

confidence: 99%

Early postoperative MRI in detecting hematoma and dural compression after lumbar spinal decompression: prospective study of asymptomatic patients in comparison to patients requiring surgical revision

et al. 2010

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“…Although our patient had none of these risk factors, coagulopathy is a risk even in those without a history. One important factor for postoperative SEH is meticulous hemostasis during the procedure in patients with or without risk [7,22]. In the present case, although hemostasis was considered adequate during the initial surgery, rebleeding may have been caused by sudden elevation of the pressure while straining to ambulate.…”

Section: Discussionmentioning

confidence: 72%

“…Since Jackson described the first case of SEH in 1869 [3], several hundred cases with various etiologies and risk factors such as an age of older than 60 years, Rh-positive blood type, and multilevel procedures (more than five levels) have been reported [1,7,17]. Preoperative nonsteroidal anti-inflammatories use, hemoglobin less than 10 g/dL, and preoperative and postoperative coagulopathy were also identified as predisposing factors that can be prevented or corrected [1,7,17]. Although our patient had none of these risk factors, coagulopathy is a risk even in those without a history.…”

Section: Discussionmentioning

confidence: 99%

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Case Report: Cauda Equina Syndrome Associated With an Interspinous Device

Limthongkul

Yingsakmongkol

2012

Clinical Orthopaedics &Amp; Related Research

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Background Although postoperative spinal epidural hematoma (SEH) is not uncommon, hematomas that require surgery are rare. Cauda equina syndrome (CES) may be associated with postoperative SEH. In these cases, early recognition and emergency decompression can prevent further damage and better neurologic recovery. Case Description A 41-year-old man underwent twolevel discectomy with insertion of an interspinous spacer at L3-4 and L4-5 because of low back pain and radiculopathy. Eight hours after the operation, the patient developed CES. MRI revealed SEH compressing posteriorly at the L3-4 level. On emergency decompression and hematoma evacuation, the interspinous spacer had obstructed the laminotomy site at L3-4 completely, blocking drainage to the drain. The patient experienced complete neurologic recovery by 2 months followup. Literature Review Many studies report risk factors for SEH. However, postoperative SEH can also be encountered in patients without these risks. One study reported a critical ratio (preoperative versus postoperative cross-sectional area) correlated with postoperative symptoms, especially in those with CES. The propensity to develop CES is likely dependent on a number of patient-specific factors. Clinical Relevance Surgeons should be aware that patients without risk factors may develop acute CES. Wider laminotomy (larger than half of the device size) may help to prevent this complication when one uses the compressible type of device, especially in patients with relatively small lamina.

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“…82 Risk factors for developing epidural hematomas with spinal cord compression include multilevel decompressions and patients with coagulopathy. 51 Emergency decompression should be performed within 8 hours as most patients will make good or partial neurological recovery. 84 Epidural abscesses are also a potential cause of spinal cord compression postoperatively and are very rare.…”

Section: Postoperative Causes Of Scimentioning

confidence: 99%

Prevention, identification, and treatment of perioperative spinal cord injury

Ahn¹,

Fehlings

2008

FOC

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Object In this report, the authors suggest evidence-based approaches to minimize the chance of perioperative spinal cord injury (POSCI) and optimize outcome in the event of a POSCI. Methods A systematic review of the basic science and clinical literature is presented. Results Authors of clinical studies have assessed intraoperative monitoring to minimize the chance of POSCI. Furthermore, preoperative factors and intraoperative issues that place patients at increased risk of POSCI have been identified, including developmental stenosis, ankylosing spondylitis, preexisting myelopathy, and severe deformity with spinal cord compromise. However, no studies have assessed methods to optimize outcomes specifically after POSCIs. There are a number of studies focussed on the pathophysiology of SCI and the minimization of secondary damage. These basic science and clinical studies are reviewed, and treatment options outlined in this article. Conclusions There are a number of treatment options, including maintenance of mean arterial blood pressure > 80 mm Hg, starting methylprednisolone treatment preoperatively, and multimodality monitoring to help prevent POSCI occurrence, minimize secondary damage, and potentially improve the clinical outcome of after a POSCI. Further prospective cohort studies are needed to delineate incidence rate, current practice patterns for preventing injury and minimizing the clinical consequences of POSCI, factors that may increase the risk of POSCI, and determinants of clinical outcome in the event of a POSCI.

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Risk Factors for Spinal Epidural Hematoma After Spinal Surgery

Abstract: Patients who require multilevel lumbar procedures and/or have a preoperative coagulopathy are at a significantly higher risk for developing a postoperative epidural hematoma.

Cited by 280 publications

References 20 publications

Early postoperative MRI in detecting hematoma and dural compression after lumbar spinal decompression: prospective study of asymptomatic patients in comparison to patients requiring surgical revision

Early postoperative MRI in detecting hematoma and dural compression after lumbar spinal decompression: prospective study of asymptomatic patients in comparison to patients requiring surgical revision

Case Report: Cauda Equina Syndrome Associated With an Interspinous Device

Prevention, identification, and treatment of perioperative spinal cord injury

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