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

Knusel, Konrad; Du, Jerry Y.; Ren, Bryan O; Kim, Chang‐Yeon; Ahn, Uri M.; Ahn, Nicholas U.

doi:10.1007/s11420-019-09690-2

Cited by 16 publications

(30 citation statements)

References 39 publications

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“…In rare cases, such a hematoma may cause critical compression of the thecal sac and result in a SPEH. While the majority of large studies evaluating the incidence of SPEH in the lumbar spine report rates of 0.10%–0.86%,5,7–9,11,17–24 higher incidence ranging from 1.29% to 6.20% has been reported in some recent series 12,13,15,22,25,26…”

Section: Epidemiologymentioning

confidence: 98%

“…Amiri et al19 described a 0.23% incidence of SPEH in a series of 2186 patients undergoing all types of lumbar surgery, with 100% of cases of SPEH occurring in multilevel procedures. A 2019 query of the NSQIP database for all lumbar decompressions noted an OR of 1.70 for surgeries involving 2 or more levels in the setting of overall SPEH incidence of 0.27% 22…”

Section: Etiologymentioning

confidence: 99%

“…A 2019 query of the NSQIP database for all lumbar decompressions noted an OR of 1.70 for surgeries involving 2 or more levels in the setting of overall SPEH incidence of 0.27%. 22…”

Section: Etiology Risk Factorsmentioning

confidence: 99%

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Symptomatic Postoperative Epidural Hematoma in the Lumbar Spine

Butler

Donnally

Goz

et al. 2021

Clinical Spine Surgery: A Spine Publication

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A symptomatic postoperative epidural hematoma (SPEH) in the lumbar spine is a complication with variable presentation and the potential to rapidly cause an irrecoverable neurological injury. Significant heterogeneity exists among current case series reporting SPEH in the literature. This review attempts to clarify the known incidence, risk factors, and management pearls. Currently, literature does not support the efficacy of subfascial drains in reducing the incidence of SPEHs and possibly suggests that medication for thromboembolism prophylaxis may increase risk. Acute back pain and progressing lower extremity motor weakness are the most common presenting symptoms of SPEH. Magnetic resonance imaging is the mainstay of diagnostic imaging necessary to confirm the diagnosis, but if not acutely available, an immediate return to the operative theater for exploration without advanced imaging is justified. Treatment of a SPEH consists of emergent hematoma evacuation as a delay in repeat surgery has a deleterious effect on neurological recovery. Outcomes are poorly defined, though a significant portion of patients will have lasting neurological impairments even when appropriately recognized and managed.

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Section: Epidemiologymentioning

confidence: 98%

Section: Etiologymentioning

confidence: 99%

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Symptomatic Postoperative Epidural Hematoma in the Lumbar Spine

Butler

Donnally

Goz

et al. 2021

Clinical Spine Surgery: A Spine Publication

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“…For the scope of our review, the definition associated with clinically significant EDH was used. The incidence of clinically significant EDH formation following lumbar spine surgery is reported in the literature to be 0.1% to 0.27% [26,[33][34][35][36]. Risk factors associated with EDH following lumbar spine surgery include the use of gel foam to cover the dura, elevated diastolic blood pressure [32], intraoperative EBL greater than one litre [26,33], history of coagulopathy [35], multilevel operations [26,34,35], older age, longer duration of operation, obesity and repair of torn dura [34].…”

Section: Incidence and Risk Factors Of Postoperative Edhmentioning

confidence: 99%

Drains in Spine Surgery for Degenerative Disc Diseases: A Literature Review to Determine Its Usage

Fowler¹,

Arshad²,

Siddiqi³

2022

Cureus

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No guidelines currently exist for surgeons to follow regarding drain use after spine surgery for degenerative disc disease. Therefore, we conducted a literature review to determine what situations warrant drain placement versus those which do not. When placed, we further investigate optimal drain duration. The goal of this article is to provide spine surgeons insight into the current literature and guidance when deciding if a drain should be used or discontinued. We performed a PubMed search and analyzed 44 peer-reviewed journal articles. Only studies that had the full article available were included. The highest-quality studies that were reviewed, demonstrated that in most situations using a drain is not associated with superior outcomes. It revealed that when drains are retained for a longer duration they run a greater risk of surgical site infection (SSI). Additionally, drains are associated with increased blood loss, a greater chance of requiring blood transfusions, and longer hospital stays. We conclude that drains are currently being overused in spine surgery for cases of degenerative disc disease, which exposes patients to unnecessary complications while providing minimal benefit.

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“…Several studies identified risk factors for development of spinal epidural hematomas, including perioperative transfusion 91 , high intraoperative blood loss (> 1 liter) 98 , pathologic coagulation values, cigarette smoking 97 , intraoperative use of gelfoam for dura coverage, postoperative drain output 100 , increased age, obesity, multilevel surgery, and dural tear repair 102 . Although no studies have specifically investigated anticoagulation use in these high-risk patients, one may want to refrain from administering chemoprophylaxis.…”

Section: - Does the Concern For Epidural Hematoma Influence The Choic...mentioning

confidence: 99%

Recommendations from the ICM-VTE: Spine

2022

Journal of Bone and Joint Surgery

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The ICM-VTE Spine Delegates* 1 -Is routine screening for DVT required in the preoperative and/or post-operative period for patients undergoing spine procedures?Response/Recommendation: There is no role for routine screening for deep venous thrombosis (DVT) in patients undergoing spine procedures. Doppler ultrasonography surveillance may be considered in high-risk surgical patients including those who are older, with spine injury, personal history of VTE, malignancy, cervical spondylotic myelopathy (CSM), and/or non-ambulatory.Strength of Recommendation: Limited.Delegates vote: Agree 96.43% Disagree 3.57% Abstain 0.00% (Strong Consensus).Rationale: Venous thromboembolism (VTE) is a wellknown complication of major orthopaedic and spine surgeries. The reported incidence of VTE in patients undergoing spine surgery range from 0.29% -31% 1-3 . Moreover, the overall rates of pulmonary (PE) and associated fatality after spinal surgery are 1.38% and 0.34%, respectively [2][3][4][5] .Although contrast venography has been used for diagnosis of DVT, it is not suitable for the routine screening of asymptomatic patients due to potential complications, technical issues, expense, and invasiveness 6 . Similarly, the use of D-dimer, a byproduct of fibrinolysis 7 , as a screening tool lacked sensitivity and specificity in detecting VTE after hip arthroplasty [8][9][10][11][12] . Ultrasonography, on the other hand, has become the primary non-invasive method for investigating suspected DVT of the femoral and popliteal veins 9 . Standard ultrasound showed relatively high sensitivity (> 90%) for proximal or (around 60%) for below-the-knee DVT in a systematic review of diagnostic cohort studies 13 . Duplex ultrasonography (DUS) has also improved precision and efficiency in diagnosing DVT compared to most non-invasive techniques 14 . Furthermore, combined D-dimer and ultrasound screening in patients with acute spinal cord injury have improved the detection of VTE compared to D-dimer screening alone 15 .However, controversy remains regarding the use of routine screening for DVT in the perioperative period for patients undergoing spine procedures. We performed an extensive systematic review of all publications. A total of 26 articles that satisfied all inclusion criteria were selected for data extraction after full review. Information about these studies with respect to year of publication, level of evidence, number of patients, methods of screening, timing of screening, methods of prophylaxis, and incidence of VTE are summarized in Table I. Studies suggest against screening for patients undergoing spine surgery while others recognize that only patients at high risk may benefit. Based on the available literature, the risk factors for an increased risk of VTE in patients undergoing spine surgery may be seen in older patients, long periods of bedrest from paralysis and pain, high D-dimer level, longer duration of operation, intraoperative blood loss and transfusion, previous history of VTE, fracture, comorbid disease burden and tumor surgery...

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

Cited by 16 publications

References 39 publications

Symptomatic Postoperative Epidural Hematoma in the Lumbar Spine

Symptomatic Postoperative Epidural Hematoma in the Lumbar Spine

Drains in Spine Surgery for Degenerative Disc Diseases: A Literature Review to Determine Its Usage

Recommendations from the ICM-VTE: Spine

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