Prospective Study of Postoperative Lumbar Epidural Hematoma

Sokolowski, Mark J.; Garvey, Timothy A.; Perl, John; Sokolowski, Margaret Szewczyk; Cho, Woojin; Mehbod, Amir A.; Dykes, Daryll C.; Transfeldt, Ensor E.

doi:10.1097/brs.0b013e31815e39af

Cited by 154 publications

(114 citation statements)

References 16 publications

Supporting

Mentioning

111

Contrasting

Order By: Relevance

“…Until now it is not known, what are the differences in MRI between the patients requiring revision surgery for symptomatic epidural compression by hematoma in the early postoperative period and those with uneventful course, since mass effect in early postoperative MRI is a common finding and can be regarded as ''normal'' [6,7]. In the literature the correlation between clinical symptoms and radiological findings of early postoperative MRI is found to be low [5,7,8].…”

Section: Discussionmentioning

confidence: 99%

“…The sparse literature on characteristics of MRI in the early postoperative period after decompression in lumbar spinal stenosis reported various rates of hematoma [8,9]. Only one study reported dimensions of hematoma and cross-sectional area (CSA) of dural sac pre-and postoperatively in patients with different surgical approaches [8,9].…”

Section: Introductionmentioning

confidence: 99%

“…Only one study reported dimensions of hematoma and cross-sectional area (CSA) of dural sac pre-and postoperatively in patients with different surgical approaches [8,9]. There is also lack of information on early postoperative MRI after lumbar decompression in patients with uneventful postoperative course.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

show abstract

“…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%

“…Postoperative spinal epidural hematoma (SEH) is not an uncommon condition; in asymptomatic patients, postoperative MRI and CT studies have identified postoperative SEH in 33% to 100% after lumbar disc or decompression surgery [6,15,17,20]. In contrast, the incidence of postoperative SEH that necessitates surgical decompression ranges from 0.1% to 3% [1,2,7,8].…”

Section: Introductionmentioning

confidence: 99%

Case Report: Cauda Equina Syndrome Associated With an Interspinous Device

Limthongkul

Yingsakmongkol

2012

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

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.

show abstract