Incidence of postoperative symptomatic epidural hematoma in spinal decompression surgery

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Neurological deterioration due to spinal epidural hematoma (SEH) is a rare but significant complication of spinal surgery. The frequency of hematoma evacuation after spinal surgery is reportedly 0.1%–3%. The objective of this study was to investigate the symptomatology of SEH and the frequency of evacuation for each surgical procedure after spinal decompression surgery.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>This is a retrospective study of 26 patients who underwent SEH evacuation after spinal decompression surgery between 1986 and 2005. During this period, 6356 spinal decompression surgeries were performed. The factors studied were the frequency of SEH evacuation for each surgical procedure, symptoms, time to SEH evacuation, comorbidities, and neurological recovery.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The frequency of SEH evacuation was 0.41% (26 of 6356) for all operations. The frequency for each surgical procedure was 0% (0 of 1568) in standard lumbar discectomy, 0.50% (8 of 1614) in lumbar laminectomy, 0.67% (8 of 1191) in posterior lumbar interbody fusion, 4.46% (5 of 112) in thoracic laminectomy, 0.44% (4 of 910) in cervical laminoplasty, and 0.21% (1 of 466) in cervical anterior spinal fusion. Nine patients had comorbidities involving hemorrhage. Spinal epidural hematoma evacuation was performed between 4 hours and 8 days after the initial operation. Whereas severe paralysis was observed within 24 hours in most patients undergoing cervical and/or thoracic surgery, half of the patients undergoing lumbar surgery had symptoms of SEH such as leg pain or bladder dysfunction after suction drain removal. The shorter the period to evacuation, the better were the results of neurological recovery.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Postoperative SEH was most frequent after thoracic laminectomy. In cervical and thoracic surgeries, symptoms of SEH were noted within 24 hours, mostly severe paralysis, and almost half of the lumbar surgery patients had symptoms after suction drain removal.</jats:p></jats:sec>

A multi-center study of reoperations within 30 days of spine surgery

“…The leading cause of reoperations, following thoracic spine surgery, was the development of postoperative epidural hematomas, whereas SSIs were the dominant cause of reoperations in cervical and lumbar surgeries. The thoracic spinal cord has been documented to be susceptible to ischemic injury and damage due to postoperative epidural hematomas because of its reduced blood supply and the physiologic kyphotic alignment [23][24][25].…”

Use of closed suction devices and other drains in spinal surgery: results of an online, Germany-wide questionnaire

“…Drains are thought to reduce the amount of hematoma and seroma formation, thereby minimizing the risks of postoperative neurological deficits by spinal cord compression [1], and decreasing dead space and the likelihood of prolonged drainage from the wound so as to reduce wound infection rates. On the other hand, drains themselves may become contaminated and spread the infection to the depth of the surgical wound.…”

Large Increase in Blood Pressure After Extubation and High Body Mass Index Elevate the Risk of Spinal Epidural Hematoma After Spinal Surgery

“…[1][2][3][4][5] Although symptomatic SEH is relatively rare, 6 SEH occasionally causes clinically evident compression of the spinal cord or a nerve root, resulting in a need for surgical evacuation, hemostasis, or additional decompression surgery. [7][8][9] The reported incidence of symptomatic postoperative SEH requiring surgical treatment is only 0.1% to 0.4%. [7][8][9][10][11][12] When postoperative SEH causes severe neurological symptoms such as paralysis or bowel dysfunction, surgical intervention should be performed as early as possible to prevent a poor outcome.…”

“…[7][8][9][10][11][12] When postoperative SEH causes severe neurological symptoms such as paralysis or bowel dysfunction, surgical intervention should be performed as early as possible to prevent a poor outcome. [7][8][9] It is, therefore, important to be aware of the risk factors for postoperative SEH and ensure close monitoring after surgery.…”