Symptomatic Postoperative Spinal Epidural Hematoma after Spinal Decompression Surgery: Prevalence, Risk Factors, and Functional Outcome

Abstract

Objective Postoperative spinal epidural hematoma (pSEH) with symptomatic compression of nervous structures after spinal decompression surgery is a rare complication. Delayed evacuation may result in severe neurologic impairment. We present a large single-center analysis of the prevalence, potential risk factors, and functional recovery after pSEH. Methods A retrospective review of our institutional database of spinal decompression surgery over 15 years yielded 6,024 consecutive patients. A total of 42 patients who had undergone surgical revision due to postoperative neurologic deterioration or intractable radiating pain and radiographically confirmed pSEH were allocated to the pSEH group. A matched 3:1 control group was formed (126 patients with the same surgical procedure, same year, same sex, and similar age). Charts, surgical reports, and radiographic data were reviewed for demographics, duration of symptoms, history of medical treatment, medication, comorbidities, radiographic extension, surgical strategy, and pre- and postoperative neurologic performance. Median follow-up was 3 months. Risk factors for pSEH, complete recovery, and recovery of neurologic symptoms were analyzed with univariable and multivariable logistic regression models. Results The prevalence of pSEH in this population was 0.69% (n = 42) with these locations: 7 of 1,284 (0.54%) cervical, 1 of 774 (0.12%) thoracic, and 34 of 3,966 (0.85%) lumbar. Use of anticoagulants (p = 0.003), pathologic coagulation values in the preoperative blood test (p = 0.034), and cigarette smoking (p = 0.003) were identified as independent risk factors of pSEH. Surgery in more than one level showed a trend toward an increased risk of pSEH. Pain as the only symptom (p = 0.0001) was a significant predictor of complete recovery. Patients symptomatic with paraplegia (p = 0.026) had a significantly higher risk of a poor neurologic outcome without full recovery of neurologic symptoms. Conclusion The prevalence of pSEH was lower than previously reported incidences. Use of anticoagulants, pathologic coagulation values, and cigarette smoking were identified as independent risk factors of pSEH. Functional outcome was related to the duration between hematoma evacuation and the clinical presentation of symptomatic pSEH.

Delayed Onset Postoperative Spinal Epidural Hematoma After Lumbar Spinal Surgery: Incidence, Risk Factors and Clinical Outcomes

“…With regard to initial symptoms, our study was consistent with previous ndings that lumbar PSEH often leads to paralysis and pain [1,15]. In our study, muscle weakness was the most common symptoms regardless of the time of onset, following the dysesthesias and pain.…”

“…Another risk factors that is found to be independent associated with delayed onset PSEH is previous spinal surgery at the same level. Many previous studies investigated the role of this factor in PSEH [1,4,17]. However, only one study identi ed it as a risk factor [17].…”

“…Postoperative spinal epidural hematoma(PSEH) is a rare complication after spinal surgery, but can lead to devastating neurological de cits including sensory disturbance, lower extremities weakness, paralysis and bowel dysfunction [1,2]. Since Jackson rst described it as a clinical diagnosis in 1869, more than 1000 cases have been reported in the literature with the incidence, etiology, risk factors and outcomes.…”

Causes of lower extremity weaknesses after posterior lumbar spine fusion surgery and therapeutic effects of active surgical exploration

“…Delamarter et al [4] demonstrated in a study on dogs that when compressions to the spinal cord last for 6 h, there are no neurological recovery and progressive spinal cord necrosis. Other studies indicate that if patients with an acute spinal cord compression have had surgical decompressions within 8 h, their neurological functions will make good or partial recovery [5,6]. A timely diagnosis and urgent management of neurologic complications are very important when helping patients recover from neurological deficits after lumbar spine surgeries.…”

Causes of Lower Extremity Weaknesses After Posterior Lumber Spine Fusion Surgery and Therapeutic Effects of Active Surgical Exploration

“…[4] demonstrated in a study on dogs that when compressions to the spinal cord last for six hours, there is no neurological recovery and progressive spinal cord necrosis. Other studies indicate that if patients with an acute spinal cord compression have had surgical decompressions within eight hours, their nerurological functions will make good or partial recovery [5,6] . A timely diagnosis and urgent management of neurologic complications are very important when helping patients recover from neurological deficits after lumbar spine surgeries.…”