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

We present a rare case of spinal epidural hematoma (SEH) after thoracolumbar posterior fusion without decompression surgery for a thoracic vertebral fracture. A 42-year-old man was hospitalized for a thoracic vertebral fracture caused by being sandwiched against his back on broken concrete block. Computed tomography revealed a T12 dislocation fracture of AO type B2, multiple bilateral rib fractures, and a right hemopneumothorax. Four days after the injury, in order to promote early orthostasis and to improve respiratory status, we performed thoracolumbar posterior fusion surgery without decompression; the patient had back pain but no neurological deficits. Three hours after surgery, he complained of acute pain and severe weakness of his bilateral lower extremities; with allodynia below the level of his umbilicus, postoperative SEH was diagnosed. We performed immediate revision surgery. After removal of the hematoma, his symptoms improved gradually, and he was discharged ambulatory one month after revision surgery. Through experience of this case, we should strongly consider the possibility of preexisting SEH before surgery, even in patients with no neurological deficits. We should also consider perioperative coagulopathy in patients with multiple trauma, as in this case.

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Incidence of postoperative symptomatic epidural hematoma in spinal decompression surgery

Journal of Neurosurgery Spine ◽

10.3171/2011.3.spine10716 ◽

2011 ◽

Vol 15 (2) ◽

pp. 202-205 ◽

Cited By ~ 80

Author(s):

Hiroyuki Aono ◽

Tetsuo Ohwada ◽

Noboru Hosono ◽

Hidekazu Tobimatsu ◽

Kenta Ariga ◽

...

Keyword(s):

Spinal Surgery ◽

Surgical Procedure ◽

Epidural Hematoma ◽

Spinal Epidural Hematoma ◽

Decompression Surgery ◽

Lumbar Surgery ◽

Spinal Decompression ◽

Suction Drain ◽

Drain Removal ◽

Spinal Epidural

Object Neurological deterioration due to spinal epidural hematoma (SEH) is a rare but significant complication of spinal surgery. The frequency of hematoma evacuation after spinal surgery is reportedly 0.1%–3%. The objective of this study was to investigate the symptomatology of SEH and the frequency of evacuation for each surgical procedure after spinal decompression surgery. Methods This is a retrospective study of 26 patients who underwent SEH evacuation after spinal decompression surgery between 1986 and 2005. During this period, 6356 spinal decompression surgeries were performed. The factors studied were the frequency of SEH evacuation for each surgical procedure, symptoms, time to SEH evacuation, comorbidities, and neurological recovery. Results The frequency of SEH evacuation was 0.41% (26 of 6356) for all operations. The frequency for each surgical procedure was 0% (0 of 1568) in standard lumbar discectomy, 0.50% (8 of 1614) in lumbar laminectomy, 0.67% (8 of 1191) in posterior lumbar interbody fusion, 4.46% (5 of 112) in thoracic laminectomy, 0.44% (4 of 910) in cervical laminoplasty, and 0.21% (1 of 466) in cervical anterior spinal fusion. Nine patients had comorbidities involving hemorrhage. Spinal epidural hematoma evacuation was performed between 4 hours and 8 days after the initial operation. Whereas severe paralysis was observed within 24 hours in most patients undergoing cervical and/or thoracic surgery, half of the patients undergoing lumbar surgery had symptoms of SEH such as leg pain or bladder dysfunction after suction drain removal. The shorter the period to evacuation, the better were the results of neurological recovery. Conclusions Postoperative SEH was most frequent after thoracic laminectomy. In cervical and thoracic surgeries, symptoms of SEH were noted within 24 hours, mostly severe paralysis, and almost half of the lumbar surgery patients had symptoms after suction drain removal.

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Fracture of L2 with massive spinal epidural hematoma in a patient with ankylosing spondylitis

Osteologie/Osteology ◽

10.1055/s-0037-1619977 ◽

2011 ◽

Vol 20 (01) ◽

pp. 50-52

Author(s):

C.-M. Chou ◽

F.-C. Lien ◽

Y.-H. Huang ◽

W.-H. Chih ◽

L.-Y. Chao

Keyword(s):

Ankylosing Spondylitis ◽

Epidural Hematoma ◽

Neurological Deficits ◽

Spinal Epidural Hematoma ◽

Decompression Surgery ◽

Posterior Decompression ◽

Posterior Aspect ◽

Automobile Accident ◽

Weighted Magnetic Resonance Imaging ◽

Spinal Epidural

SummaryIt has been reported that even mild trauma may result in a fracture and a spinal epidural hematoma in patients with ankylosing spondylitis (AS). We herein presented a case of a patient with AS who sustained a fracture of L2 in an automobile accident and developed a massive spinal epidural hematoma. Findings The patient had few neurological symptoms until numbness and pain developed 50 hours after the initial trauma. T2-weighted magnetic resonance imaging showed an epidural hematoma over the posterior aspect of the spinal canal, reaching from T12 to L4. Posterior decompression surgery was performed. The neurological deficits resolved completely after the surgery. Conclusion Early surgical decompression of a massive epidural hematoma produced a favorable outcome in a patient with AS with neurological deficits.

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