The impact of hypertension on the occurrence of postoperative spinal epidural hematoma following single level microscopic posterior lumbar decompression surgery in a single institute

Fujiwara, Yasushi; Manabe, Haruhiko; Izumi, Bunichiro; Harada, Takahiro; Nakanishi, Kazuyoshi; Tanaka, Nobuhiro; Adachi, Nobuo

doi:10.1007/s00586-017-5165-9

Cited by 43 publications

(55 citation statements)

References 19 publications

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“…The relationship between blood pressure and hematoma was widely studied in previous studies [4,5,16,17]. According to our study, although univariate analysis revealed that SBP at different time point except for intraoperative were signi cant higher in delayed onset PSEH group, further multiple logistic regression analysis revealed patients with high postoperative SBP had a 1.10-fold increased risk to develop hematoma.…”

Section: Risk Factorsmentioning

confidence: 45%

“…Two possible explanations may account for it as follow: First, patients usually present an elevation in blood pressure after surgery because of wound pain, but the self-regulation mechanisms can rapidly adjust the vessels size to decrease the blood pressure. However, these poorly managed or undiscovered hypertension patients, owing to hardening vessels, self-regulation mechanism failed to regulate the vessel size and the high blood pressure may lead to hemorrhage again after surgery [16,18]; Second, previous studies have reported the positive relationship between whole blood viscosity (WBV) and hypertension [19][20][21]. The high postoperative SBP may result in high WBV that could cause blood clots and block the drainage tube.…”

Section: Risk Factorsmentioning

confidence: 99%

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Delayed Onset Postoperative Spinal Epidural Hematoma After Lumbar Spinal Surgery: Incidence, Risk Factors and Clinical Outcomes

Wang

Zeng

et al. 2020

Preprint

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Background: Posterior spinal epidural hematoma (PSEH) often develops after the surgery within 24 hours. On rare occasions, PSEH happened after 3 days, up to two weeks, which were classified as delayed onset PSEH. Due to its rarity, previous studies only described the clinical features, whereas risk factors cannot be able to assess.Methods Patients who developed PSEH requiring hematoma evacuation between December 2013 and January 2020 were included and divided into early onset (Group A) and delayed onset group (Group B) based on the time of symptom onset (72 hours). For each PSEH patients, 3 controls (Group C) who did not develop the PSEH in the same period were randomly selected. Clinical features were compared among three groups and multiple logistic regression analysis was performed to identify the risk factors for group A and B.Results 32 patients (0.35%) were identified as the early onset PSEH (occurred at 10.68  11.5h) and 15 (0.16%) patients were the delayed onset ones (occurred at 130.60  61.78h). When compare the group A and B, group A showed higher rate of multilevel procedure (Group A: 75%, Group B: 40%, p=0.02), lower drainage (Group A: 239.69±245.70, Group B: 613.67±599.83, p=0.004), lower APTT (Group A: 31.55±4.07, Group B: 35.63±7.24, p=0.018) and higher JOA score at discharge (Group A: 20.68±4.72, Group B: 17.67±4.79, p=0.039). Multiple logistic regression analysis identified multilevel procedure (OR: 5.62, 95% CI: 1.84-17.25), postoperative systolic blood pressure (SBP)(OR: 1.10, 95% CI: 1.06-1.15) and abnormal coagulation (OR: 5.68, 95% CI: 1.74-18.52) as the independent risk factors for group A, whereas for group B, postoperative SBP (OR: 1.10, 95% CI: 1.04-1.16) and previous spinal surgery (OR: 4.74, 95% CI: 1.09-20.70) at the same level were the risk factors.Conclusions Our study revealed the overall incidence of delayed onset PSEH was 0.16% in posterior lumbar spinal surgery and the risk for it was different from early onset PSEH. For the early onset PSEH, multilevel procedure, postoperative SBP and abnormal coagulation were the risk factors and for the delayed onset PSEH, the postoperative SBP and previous spinal surgery at the same level were the independent risk factors.

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Section: Risk Factorsmentioning

confidence: 45%

Section: Risk Factorsmentioning

confidence: 99%

Delayed Onset Postoperative Spinal Epidural Hematoma After Lumbar Spinal Surgery: Incidence, Risk Factors and Clinical Outcomes

Wang

Zeng

et al. 2020

Preprint

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“…Regardless of the location of postoperative hematoma, the symptoms are usually bilateral, although in our study 12 patients experienced unilateral neurological deficits ( Table 3). Cases of patients with lumbar postoperative hematoma who developed unilateral neurological symptoms have been reported 6,16) . In patients with cervical and thoracic postoperative hematoma, hemiplegia is rare.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Clinical Features of Postoperative Symptomatic Hematoma after Spine Surgery: A Multicenter Study of 45 Patients

Masuda

Fujibayashi

Takemoto

et al. 2020

Spine Surg Relat Res

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Introduction: Symptomatic postoperative hematoma after spine surgery is a rare but serious complication. The objective of this study was to investigate the incidence and clinical features of symptomatic postoperative hematoma after spine surgery. Methods: We retrospectively identified 10,680 patients who underwent spine surgery between 2002 and 2012 in nine hospitals. We reviewed the incidence of postoperative hematoma and its clinical features, including time before onset, main symptoms, and neurological outcomes. Results: The overall incidence of symptomatic postoperative hematoma after spine surgery was 0.4% (45/10,680). Postoperative hematoma was more frequent after thoracic spine surgery than after cervical or lumbar surgery. The onset of postoperative hematoma occurred at an average of 2.6 days (range 0-14 days) postoperatively. The chief symptoms caused by postoperative hematoma after spine surgery were tetra/paraplegia in 30 patients, hemiplegia in eight patients, intractable pain in five patients, and airway dysfunction in two patients. Surgical evacuation of the spinal epidural hematoma resulted in improvement of at least one grade in 35 patients, while four patients had complete motor paralysis even after evacuation surgery. Conclusions: We report the clinical details of 45 patients with postoperative hematoma after spine surgery. This information could assist surgeons to make a prompt diagnosis and perform early evacuation surgery for postoperative hematoma following spine surgery.

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“…Our search for an explanation found that Fujita et al 61 in 2018 identified that hypertension, multilevel surgery, and lordosis less than 25° were considered risk factors. On the other hand, Fujiwara et al 62 found in 2017 that hypertension and lack of debit in surgical drainage were also risk factors. Our patient had hypertension, a lordosis of 23°, and was without drainage, maybe for that reason the patient was at more risk to develop this complication.…”

Section: Discussionmentioning

confidence: 99%

Comparative Study Between Uniportal Full-Endoscopic Interlaminar and Tubular Approach in the Treatment of Lumbar Spinal Stenosis: A Pilot Study

Carrascosa-Granada

Velazquez²,

Wagner

et al. 2020

Global Spine Journal

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Study Design: Multicenter, prospective, randomized, and double-blinded study. Objectives: To compare tubular and endoscopic interlaminar approach. Methods: Patients with lumbar spinal stenosis and neurogenic claudication of were randomized to tubular or endoscopic technique. Enrollment period was 12 months. Clinical follow up at 1, 3, 6 months after surgery with visual analogue scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopedic Association (JOA) score. Radiologic evaluation with magnetic resonance pre- and postsurgery. Results: Twenty patients were enrolled: 10 in tubular approach (12 levels) and 10 in endoscopic approach (11 levels). The percentage of enlargement of the spinal canal was higher in endoscopic approach (202%) compared with tubular approach (189%) but was not statistically significant ( P = .777). The enlargement of the dural sac was higher in endoscopic group (209%) compared with tubular group (203%) but no difference was found between the 2 groups ( P = .628). A modest significant correlation was found between the percentage of spinal canal decompression and enlargement of the dural sac ( r = 0.5, P = .023). Both groups reported a significant clinical improvement postsurgery. However, no significant association was found between the percentage of enlargement of the spinal canal or the dural sac and clinical improvement as determined by scales scores. Endoscopic group had lower intrasurgical bleeding ( P < .001) and lower disability at 6 months of follow-up than tubular group (p=0.037). Conclusions: In the treatment of lumbar spinal stenosis, endoscopic technique allows similar decompression of the spinal canal and the dural sac, lower intrasurgical bleeding, similar symptoms improvement, and lower disability at 6 months of follow-up, as compared with the tubular technique.

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The impact of hypertension on the occurrence of postoperative spinal epidural hematoma following single level microscopic posterior lumbar decompression surgery in a single institute

Cited by 43 publications

References 19 publications

Delayed Onset Postoperative Spinal Epidural Hematoma After Lumbar Spinal Surgery: Incidence, Risk Factors and Clinical Outcomes

Delayed Onset Postoperative Spinal Epidural Hematoma After Lumbar Spinal Surgery: Incidence, Risk Factors and Clinical Outcomes

Incidence and Clinical Features of Postoperative Symptomatic Hematoma after Spine Surgery: A Multicenter Study of 45 Patients

Comparative Study Between Uniportal Full-Endoscopic Interlaminar and Tubular Approach in the Treatment of Lumbar Spinal Stenosis: A Pilot Study

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