Symptomatic Epidural Haematoma after Cervical Laminoplasty: A Report of Three Cases

Takahashi, Yoshimasa; Sato, Tetsuro; Hyodo, Hironori; Kawamata, Toru; Takahashi, Eiji

doi:10.1177/230949901602400127

Cited by 4 publications

(5 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The neurological deficit can be permanent, irreversible, and can also lead to death if the hematoma is not drained in time. 33 34 35 In our study, two patients had postoperative epidural hematoma with transient paralysis. The hematoma was drained immediately and meticulous hemostasis was achieved.…”

Section: Discussionmentioning

confidence: 65%

Cervical Laminectomy with Lateral Mass Screw Fixation in Cervical Spondylotic Myelopathy

Singrakhia¹,

Malewar²,

Singrakhia³

et al. 2017

IJOO

View full text Add to dashboard Cite

Background:Anterior cervical decompression and fusion is the standard procedure used for treating patients with cervical myelopathy. However, these procedures are associated with complications such as pseudarthrosis, construct failure, and neurological complications. Posterior cervical laminectomy and instrumentation is an alternative procedure to treat multilevel cervical myelopathy. In this study, we raised questions whether instrumentation is required at all levels and whether stabilizing the spine in neutral or lordotic contour with indirect decompression leads to neurological improvement with radiological evidence of anterior decompression. The results of posterior cervical laminectomy and instrumentation with lateral mass screw in terms of radiological and functional outcome in patients with multilevel cervical myelopathy are prospectively evaluated.Materials and Methods:In this prospective study conducted between June 2006 and December 2015, we have evaluated 112 patients with multilevel cervical myelopathy who underwent multilevel cervical laminectomy and instrumentation with lateral mass screw. All patients were evaluated preoperatively and postoperatively with Nurick's grading and Modified Japanese Orthopaedic Association (mJOA) scale for neurological function. Cooper scale and British Medical Research Council grading system for motor function. Curvature index was used to measure the alignment of cervical spine preoperatively and postoperatively. Alignment of the cervical spine was done preoperatively and postoperatively by calculating the curvature index. Axial MRI was used to calculate the severity of compression preoperatively which was calculated as per Singh's criteria and postoperatively to assess the adequacy of decompression at the operated level.Results:In our study, there were 112 patients including 99 males and 13 females, with mean age of 59.53 years. The mean duration of followup of patients was 33.24 months. In total, cervical laminectomy was performed at 342 levels in 112 patients with an average of 3.05 laminectomies, and in total, 112 lateral mass screws were inserted. On postoperative followup, the mJOA and Nurick's grading showed improvement in all cases as compared to preoperative findings. The mean mJOA improved significantly from 8.56 preoperatively to 13.57 postoperatively (P < 0.001). The mean Nurick's grading also improved significantly from 2.59 preoperatively to 0.66 postoperatively (P < 0.001). The mean Cooper scale also showed significant improvement in both upper and lower limbs postoperatively (P < 0.001). The mean preoperative Cooper scale was 1.75 and postoperative was 0.31 for upper limbs, and the mean Cooper scale was 2.14 preoperatively and 0.56 postoperatively for lower limbs. X-rays done on routine followups showed good alignment of the cervical spine with maintenance of curvature index in all patients. The mean grade of compression as seen on preoperative MRI was 2.46 which reduced significantly postoperatively to 0.16 (P < 0.001).Conclusion:The multilevel cervical...

show abstract

Section: Discussionmentioning

confidence: 65%

Cervical Laminectomy with Lateral Mass Screw Fixation in Cervical Spondylotic Myelopathy

Singrakhia¹,

Malewar²,

Singrakhia³

et al. 2017

IJOO

View full text Add to dashboard Cite

show abstract

“…Several reports have described symptomatic postoperative EH after posterior cervical spine surgery [2][3][4][5][6] . Recently, Schroeder et al investigated retrospectively a total of 16,582 cervical spine surgeries (8,887 anterior procedures and 7,695 posterior procedures) across multiple centers, and reported fewer EHs in anterior procedures (5.63 per 10,000 anterior cases) than in posterior procedures (13.00 per 10,000 posterior cases) 20) .…”

Section: Discussionmentioning

confidence: 99%

“…Recently, Schroeder et al investigated retrospectively a total of 16,582 cervical spine surgeries (8,887 anterior procedures and 7,695 posterior procedures) across multiple centers, and reported fewer EHs in anterior procedures (5.63 per 10,000 anterior cases) than in posterior procedures (13.00 per 10,000 posterior cases) 20) . Most hematomas often result in a sudden inability to move the extremities just after surgeries 2,6) . Yet, a case report presenting three patients with severe neck pain on physical examination showed a slow-growing postoperative EH despite normal motor function 4) .…”

Section: Discussionmentioning

confidence: 99%

“…A previous study identified the risk factors of postoperative retropharyngeal hematoma as (1) diffuse idiopathic skeletal hyperostosis, (2) ossi-fication of the posterior longitudinal ligament (OPLL), (3) therapeutic heparin use, (4) longer operative time, and (5) greater number of surgical levels 1) . On the contrary, after posterior cervical spine surgery, postoperative epidural hematoma (EH) can cause various symptoms including paralysis 2,3) and intolerable neck pain 4,5) , with urgent surgical removal of the hematoma sometimes needed 6) . It remains unclear what risk factors are associated with postoperative EH after posterior cervical spine surgery.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A New Grading of Epidural Hematoma or Scar Formation after Posterior Cervical Spine Surgery: Evaluation of Perioperative Related Factors, Distributions, and Clinical Outcomes after Surgery

Takeuchi¹,

Yokoyama²,

Wada

et al. 2019

Spine Surg Relat Res

View full text Add to dashboard Cite

Introduction The purpose of this study was to evaluate surgical outcomes using a new grading of postoperative epidural hematoma (EH) or epidural scar formation after posterior cervical spine surgery. Methods Postoperative EH or epidural scar formation after cervical laminoplasty (LP) or posterior decompression and fusion (PDF) were graded into Grades 1-5 by magnetic resonance imaging at 24 hours, 2 weeks, 6 months, and one year after surgery. The patients were divided into the Mild group (Grades 1-3) and the Severe group (Grades 4, 5). Perioperative factors were compared between the two groups at 24 hours after surgery. Distribution of EH or scar formation was investigated according to two surgeries. The recovery rate of Japanese Orthopedic Association (JOA) scores and the improvements of neck disability index (NDI) were compared between the two groups at one year postoperatively. Results Of the postoperative factors, posterior shift of the cervical spinal cord at C4 and C7 significantly differed between the two groups. Patients in the Severe group at 24 hours after surgery (17%) increased to 41% at 2 weeks and subsequently decreased to 16% at 6 months after LP. After PDF, 3% in the Severe group at 24 hours after surgery increased to 15% at 2 weeks and then decreased to 3% at 6 months postoperatively. Only one (3%) patient remained in the Severe group at 1 year after PDF. The recovery rate of JOA score (47.5%) of the patients in the Mild group showed trend larger than that of the Severe group (34.7%) after LP. Preoperative NDI (15.6 points) significantly improved postoperatively to 12.1 points in only the Mild group after LP. Conclusions The patterns of distribution of EH or scar formation did not differ between the two surgical methods. The severity of postoperative scar formation related to surgical outcomes after LP.

show abstract

“…The risk factors responsible for the delayed appearance of the EDH "tamponade" effect are usually increased endocranial pressure and post-traumatic arterial hypotension, as well as coagulopathy in a limited number of cases [13,14,15]. Post-traumatic nasal and ear leakage of the cerebrospinal fluid may result in the occurrence of DEDH.…”

Section: Disscusionmentioning

confidence: 99%

A combination of acute and delayed contralateral epidural hematoma

Kostić¹,

Veselinović

Nikolov³

et al. 2018

Srp Arh Celok Lek

View full text Add to dashboard Cite

Introduction An acute bilateral extradural hematoma is an uncommon presentation of a traumatic head injury; however, it leads to higher mortality rate than an acute unilateral hematoma. A delayed epidural hematoma (DEDH) is a hematoma not present on the initial computed tomography (CT) scan but is found on a subsequent CT scan. While reviewing the literature, we could not find recently published papers considering supratentorial DEDH after primary operated contralateral epidural hematoma. Case outline A comatose 14-year-old male patient with Glasgow Coma Scale score of 4 and the right mydriatic pupil on the side of the blunt trauma to the head was admitted to the intensive care unit after he had survived a traffic accident. The initial brain CT scan showed an acute temporoparietal epidural hematoma on the right side of the cranium, with impressive midline shift and bilateral linear skull fracture. Surgery was performed and an intracranial pressure (ICP) monitor was implanted, which showed increased values of ICP. A control brain CT scan performed within 24 hours showed a new contralateral occipitoparietal epidural hematoma. Another operation was performed. A second, control CT brain scan showed favorable findings. The patient was transferred after 25 days to the rehabilitation center, with the disability rating score of 11, which was reduced to 1 after three months. Conclusion A contralateral DEDH is a life-threatening neurosurgical emergency case which can occur during the first 24 hours after decompressive craniectomy. Control CT scans should be performed one day after the operation in order to verify and treat DEDH timely. A high degree of vigilance and ICP monitoring is recommended in these cases, especially after surgical decompression.

show abstract

Symptomatic Epidural Haematoma after Cervical Laminoplasty: A Report of Three Cases

Cited by 4 publications

References 11 publications

Cervical Laminectomy with Lateral Mass Screw Fixation in Cervical Spondylotic Myelopathy

Cervical Laminectomy with Lateral Mass Screw Fixation in Cervical Spondylotic Myelopathy

A New Grading of Epidural Hematoma or Scar Formation after Posterior Cervical Spine Surgery: Evaluation of Perioperative Related Factors, Distributions, and Clinical Outcomes after Surgery

A combination of acute and delayed contralateral epidural hematoma

Contact Info

Product

Resources

About