Massive lumbar spine hematoma post-spinal tap

Jishi, Ahmed Al; Murty, Naresh K.

doi:10.4103/sni.sni_351_17

Cited by 4 publications

(4 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Given the rare nature of both conditions, our study may have been able to demonstrate this association due to our greater number of cases compared to prior studies [12, 27]. Past case reports have investigated this association by reporting symptomatic epidural hematomas following lumbar puncture [2, 16, 32]. A possible explanation is that incidental durotomy damages the local vasculature, thereby contributing to post-operative hematoma formation.…”

Section: Discussionmentioning

confidence: 74%

Symptomatic Epidural Hematoma after Elective Posterior Lumbar Decompression: Incidence, Timing, Risk Factors, and Associated Complications

Knusel

Ren

et al. 2020

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

View full text Add to dashboard Cite

Background: Symptomatic post-operative lumbar epidural hematoma (PLEH) is a complication of lumbar spine surgery that can cause permanent neurologic consequences through compression of the cauda equina and nerve roots. Questions/Purposes: We sought to investigate the incidence, timing, and risk factors for symptomatic epidural hematomas following posterior lumbar decompression, as well as to identify additional post-operative complications associated with symptomatic lumbar epidural hematomas. Methods: Elective lumbar spine procedures were identified in the National Surgical Quality Improvement Program (NSQIP) database between 2012 and 2016. Analyzed predictors of reoperation or readmission within 30 days for symptomatic PLEH included demographics, comor-bidities, pre-operative laboratory values, peri-operative characteristics, and post-operative complications. Results: There were 75,878 cases included in the analysis. The incidence rate of symptomatic PLEH was 0.27% (n = 206), 54.4% (n = 112) of which occurred within 5 days of the procedure. Increased age, obesity (body mass index of 35 or higher), peri-operative transfusion, multilevel surgery (two or more levels), dural tear repair, and microscope use were independently associated with PLEH. Post-operative complications associated with PLEH included surgical site infection and urinary tract infection. Conclusions: Readmission or reoperation for symptomatic PLEH following elective lumbar spine surgery is rare and can occur many days or weeks after a procedure. There are modifiable risk factors for PLEH and associated additional post-operative complications that physicians should be suspicious of following posterior lumbar decompression.

show abstract

Section: Discussionmentioning

confidence: 74%

Symptomatic Epidural Hematoma after Elective Posterior Lumbar Decompression: Incidence, Timing, Risk Factors, and Associated Complications

Knusel

Ren

et al. 2020

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

View full text Add to dashboard Cite

show abstract

“…8,27,[38][39][40] Of note, case reports have described symptomatic PSEH following lumbar punctures. [41][42][43] Incidental durotomy may damage the epidural venous plexus, increasing risk of PSEH.…”

Section: Discussionmentioning

confidence: 99%

Symptomatic Epidural Hematoma After Elective Cervical Spine Surgery: Incidence, Timing, Risk Factors, and Associated Complications

Abola¹,

Du²,

Lin³

et al. 2021

ONSURG

View full text Add to dashboard Cite

BACKGROUND As the rate of elective cervical spine surgery increases, studies of complications may improve quality of care. Symptomatic postoperative cervical epidural hematomas (PCEH) are rare but result in significant morbidity. Because of their low incidence, the risk factors and complications associated with symptomatic PCEH remain unclear. OBJECTIVE To clarify the prevalence, timing, variables, and complications associated with PCEH following elective cervical spine surgery. METHODS Using the American College of Surgeons National Surgical Quality Improvement Program database, cervical spine surgeries performed between 2012 and 2016 were identified using Current Procedural Terminology codes. Symptomatic PCEH was defined as readmission or reoperation events specifically associated with International Classification of Diseases code diagnoses of postoperative hematoma within 30 d of index surgery. Multivariate models were created to assess the independent association of symptomatic PCEH with other postoperative complications. RESULTS There were 53233 patients included for analysis. The overall incidence of symptomatic PCEH was 0.4% (n = 198). Reoperation occurred in 158 cases (78.8%), of which 2 required a second reoperation (1.3%). The majority (91.8%) of hematomas occurred within 15 d of surgery. Multivariate analysis identified male gender, American Society of Anesthesiologists classes 3 to 5, bleeding disorder, increasing number of operative levels, revision surgery, dural repair, and perioperative transfusion as independent factors associated with PCEH. Upon controlling for those confounders, PCEH was independently associated with cardiac arrest, stroke, deep vein thrombosis, surgical site infection, and pneumonia. CONCLUSION Postoperative epidural hematomas requiring readmission or reoperation following elective cervical spine surgery occurred at an incidence of 0.4%. Symptomatic PCEHs are associated with increased rates of numerous major morbidities.

show abstract

“…Also, the routine lumbar puncture needs to be given due diligence and preprocedural care considering these structural variants and their possible role in causing postprocedural complications (1).…”

Section: A B Cmentioning

confidence: 99%

“…Underlying coagulopathies had been implicated as the reason for such complications by few case reports (1,3,17,18). Nevertheless, the variant venous patterns and engorged venous drainage as seen in this study were implicated as the probable underlying structural basis for such needle site A B Total number of radicular veins exiting through separate foramen 2 addition, the engorged radicular veins that commonly exit through the same foremen as that of the dorsal spinal nerve roots also need to be considered as causative factor for post procedure hemorrhagic complications.…”

Section: █ Conclusionmentioning

confidence: 99%

Revisiting intrathecal dorsal venous patterns of the spinal cord at thoracolumbar level as probable factor for post lumbar puncture spinal hematoma

Arivalagan

Ts²

2021

Turkish Neurosurgery

View full text Add to dashboard Cite

AIM:To evaluate the extrinsic dorsal venous pattern of spinal cord at the thoracolumbar level hypothesizing that any variant of these intrathecal venous pattern as probable factor for post lumbar pucture hemorrhagic complications. MATERIAL and METHODS:In a tertiary teaching institution, 25 adult cadavers were dissected by standard dissection procedure and spinal cord was removed with meninges. The dorsal aspect was further dissected out and layers of meninges were removed carefully to expose the extrinsic venous system in the dorsal region. The specimens that showed engorged veins were further studied for their extent, pattern, presence of radicular veins, their level and route of exit. RESULTS:Five specimens showed variant dorsal venous pattern of the extrinsic system of veins in the thoracolumbar region. The main dorsal spinal vein was seen to be engorged, tortuous and more than 2mm with engorged radicular veins. Out of 8 engorged radicular veins observed, 6 exited through the dorsal nerve root foramen and 2 exited through a separate foramen. CONCLUSION:The variant anatomy of intrathecal extrinsic venous system with engorgement of the thoracolumbar region veins might get injured during lumbar puncture procedure. The exit of radicular veins and the dorsal nerve root through the same foramen also makes the veins susceptible to post procedural spinal hematomas.

show abstract

Massive lumbar spine hematoma post-spinal tap

Cited by 4 publications

References 4 publications

Symptomatic Epidural Hematoma after Elective Posterior Lumbar Decompression: Incidence, Timing, Risk Factors, and Associated Complications

Symptomatic Epidural Hematoma after Elective Posterior Lumbar Decompression: Incidence, Timing, Risk Factors, and Associated Complications

Symptomatic Epidural Hematoma After Elective Cervical Spine Surgery: Incidence, Timing, Risk Factors, and Associated Complications

Revisiting intrathecal dorsal venous patterns of the spinal cord at thoracolumbar level as probable factor for post lumbar puncture spinal hematoma

Contact Info

Product

Resources

About