Management and outcomes of spinal epidural hematoma during vertebroplasty

Fang, Miao; Zhou, Jiaojiao; Yang, Dezhi; He, Yu; Xu, Yong; Liu, Xin; Zeng, Yong

doi:10.1097/md.0000000000010732

Cited by 3 publications

(5 citation statements)

References 20 publications

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“…Domenicucci et al 19 reviewed 1,010 SEH cases in 16 years and concluded that 18% of the significant cases were iatrogenic (spinal puncture), while 29% were non-iatrogenic and caused by factors such as clotting, trauma, and pregnancy. However, iatrogenic SEH after PKP or PVP has been reported in seven previous studies [11][12][13][14][15][16][17] (Table 1). Wang et al 11 suspected that SEH after PKP was caused by direct injury from intraoperative puncture.…”

Section: Discussionmentioning

confidence: 95%

“…This finding was supported by three other studies. [12][13][14] Mattei et al 15 suggested that venous congestion plays a pivotal role in the etiology of SEH. von der Brelie et al 16 attributed the development of SEH after PVP in a patient with long-term oral aspirin to coagulation malfunction owing to aspirin.…”

Section: Discussionmentioning

confidence: 99%

“…10 As an emergency complication, spinal epidural hematoma (SEH) is clinically rare after PKP or percutaneous vertebroplasty (PVP), and has been reported in seven studies. [11][12][13][14][15][16][17] In this report, we present the case of a patient on long-term anticoagulants who developed acute SEH after PKP without signs of major cement extravasation to the spinal canal. Further, we comprehensively review the relevant literature on the possible pathogenesis of SEH.…”

Section: Introductionmentioning

confidence: 99%

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<p>Spinal Epidural Hematoma After Percutaneous Kyphoplasty: Case Report and Literature Review</p>

Zou

Gong

Wei³

et al. 2020

JPR

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Objective To present the case of a patient on long-term anticoagulants who developed acute spinal epidural hematoma (SEH) after percutaneous kyphoplasty (PKP) without signs of major cement extravasation to the spinal canal. Methods A 64-year-old woman with long-term oral antiplatelet drugs underwent the L1 PKP. Immediately after the operation, the back pain improved significantly without neurological deficit. However, 12 hours later, she developed progressive weakness of the bilateral lower limbs. No intraspinal cement leakage was obvious on the postoperative lumbar radiograph and computed tomography. Results An emergency MRI examination revealed a high signal aggregation in front of the spinal cord from T12 to L1, indicating spinal cord compression. The SEH was verified and removed during the laminectomy from T12–L1. Following the decompression surgery, the neurological deficit of the lower limbs improved. On follow-up after 6 months, the muscle strength of the bilateral lower limbs had returned to normal. Conclusion For the patient with long-term oral antiplatelet drugs or coagulation malfunction, the transpedicle approach or that via the costovertebral joint with a smaller abduction angle is recommended to reduce the risk of injury to the inner wall of the pedicle. For progressive aggravation of neurological dysfunction after surgery, SEH formation should be suspected despite the absence of intraspinal bone cement leakage. Secondary emergency decompression should be considered to avoid permanent damage to spinal cord nerve function caused by continuous compression.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

<p>Spinal Epidural Hematoma After Percutaneous Kyphoplasty: Case Report and Literature Review</p>

Zou

Gong

Wei³

et al. 2020

JPR

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“…According Fang et al (2018) 9 a poor prognosis and permanent injury can be associate an inappropriate management of spinal epidural hematoma (SEH), being this pathology an emergent complication. Figure 2 shows an EDH that extends from the level of the second cervical vertebra to the sixth cervical vertebra.…”

Section: Physiopathologymentioning

confidence: 99%

“…Fang et al (2018) 9 suggest that exploratory surgery is a good option in patients who incurs spinal cord injury during vertebroplasty, because neurological deficits occurs secondary to acute spinal epidural hematoma (SEH). Moreover, theses authors affirm that neurological recovery is multifactorial, and the key for the postsurgical success is the timing of surgery, and timely decompression and transfer surgery have a special function to shorten the time of patient recovery.…”

Section: Physiopathologymentioning

confidence: 99%

Epidural Hematoma: A Systematic Review

Tacconi¹,

Barroso²,

Azevedo³

et al. 2021

JMS

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Introduction: epidural hematoma (EDH) is an event that can result in mortality and morbidity. Understanding it is critical to a fast diagnosis that enables successful management. In the perspective, this article aim to analyze the physiopathology of epidural hematoma. Specifically, the proposal develops a survey on the literature that covers the topic of epidural hematoma, to update and review in case reports the neurological damage and to seek the new concepts relative to the surgical practice, using the method of bibliographic study. Besides to bring some epidemiological data about this theme in Brazil in recent years. The results showed that the risks involved in the occurrence of an EDH go far beyond physical impacts, tumor lesions and infections, extending to cases of hemorrhage due to the use of drugs. Based on the DataSUS, there are no significant variations in hospitalizations due to intracranial hemorrhage or intracranial trauma in recent years. For treatment, minimally invasive surgery is one of the best alternatives to treat patients with EDH due to small incisions, reduced surgical time, reduced risk of anesthesia and avoid craniotomy. It is concluded that epidural hematoma requires an early diagnosis so that surgical intervention prevents other avoidable complications from occurring. Besides that, the public health system needs to have adequate structure, effective prevention strategies and improved EDH care.

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Incidence, Risk Factors, and Outcomes of Symptomatic Bone Cement Displacement following Percutaneous Kyphoplasty for Osteoporotic Vertebral Compression Fracture: A Single Center Study

Yang

et al. 2022

JCM

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Study design: Retrospective. Background: Symptomatic bone cement displacement (BCD) is a rare complication following percutaneous kyphoplasty (PKP) interventions for osteoporotic vertebral compression fracture (OVCF). This study aimed to investigate the incidence and the outcomes of symptomatic BCD comprehensively and identify its risk factors. Methods: The clinical data of patients treated with PKP for OVCF between January 2012 and December 2020 were extracted. Patients who developed BCD following PKP during follow-up were divided into the symptomatic and asymptomatic groups. Patients who did not develop BCD were assigned to the control group. Univariate and multiple logistic regression analyses were used to compare the three clinical groups’ features to assess the independent risk factors for the symptomatic and asymptomatic groups. Results: A total of 896 patients were enrolled. Twenty-one patients (2.3%) were identified as having symptomatic BCD following PKP for OVCF, and 35 (3.9%) developed asymptomatic BCD. Compared with the control group, the symptomatic and asymptomatic groups had a higher incidence of anterior leakage, intravertebral vacuum cleft (IVC) signs, and a lower cement distribution score. The symptomatic group had a lower relative cross-sectional area (rCSA) of the paraspinal muscle (PSM), higher PSM fatty degeneration, and higher kyphotic angle (at the last follow-up) than the asymptomatic and control groups. For outcomes, the symptomatic group had a higher VAS/ODI score and a higher incidence of new vertebral fractures compared with the asymptomatic and control groups. Anterior leakage (OR: 1.737, 95% CI: 1.215–3.300), the IVC sign (OR: 3.361, 95% CI: 1.605–13.036), the cement distribution score (OR: 0.476, 95% CI: 0.225–0.904), PSM rCSA (OR: 0.953, 95% CI: 0.917–0.992), and PSM fatty degeneration (OR: 1.061, 95% CI: 1.005–1.119) were identified as independent risk factors for the symptomatic group. Anterior leakage (OR: 1.839, 95% CI: 1.206–2.803), the IVC sign (OR: 2.936, 95% CI: 1.174–9.018), and cement distribution score (OR: 0.632, 95% CI: 0.295–0.858) were independent risk factors for the asymptomatic group. Conclusion: The incidence of symptomatic BCD is 2.3% in patients treated with PKP. Anterior leakage, the IVC sign, and the distribution score were independent risk factors for BCD, and paraspinal muscle degeneration was a specific risk factor for symptomatic BCD. Symptomatic BCD can lead to poor outcomes.

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Management and outcomes of spinal epidural hematoma during vertebroplasty

Abstract: According to our experience, when SCI occurs during vertebroplasty, neurological deficits are always secondary to acute SEH. Timely decompression, particularly transfer surgery, can shorten recovery time.

Cited by 3 publications

References 20 publications

<p>Spinal Epidural Hematoma After Percutaneous Kyphoplasty: Case Report and Literature Review</p>

<p>Spinal Epidural Hematoma After Percutaneous Kyphoplasty: Case Report and Literature Review</p>

Epidural Hematoma: A Systematic Review

Incidence, Risk Factors, and Outcomes of Symptomatic Bone Cement Displacement following Percutaneous Kyphoplasty for Osteoporotic Vertebral Compression Fracture: A Single Center Study

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