Symptomatic Spinal Epidural Hematoma After Lumbar Spine Surgery: The Importance of Diagnostic Skills

<sec><title>Study Design</title>Retrospective case-control study.</sec><sec><title>Purpose</title>To examine the hypothesis that the misuse of thrombin-containing local hemostatics (TCLH) increases the risk of postoperative spinal epidural hematoma (POSEH).</sec><sec><title>Overview of Literature</title>Many studies have focused on hypocoagulability as a risk factor for POSEH. However, there are no prior reports on the increased risk of POSEH in hypercoagulable states.</sec><sec><title>Methods</title>Posterior instrumented lumbar spine surgery cases over 2 consecutive years were divided into two groups: a study group (98 patients in whom TCLH was used) and a control group (176 patients in whom TCLH was not used). The excess TCLH matrix that was not associated with blood clot was not removed from the patients in the study group. The senior author decided whether to use TCLH or not. Suction drains were used in all patients. The demographics, coagulation-related factors, and intraoperative factors of the patients in the two groups were analyzed. The development of POSEH was compared between the two groups.</sec><sec><title>Results</title>The two groups were homogenous in demographics (age and sex), coagulation-related factors (platelet count, prothrombin time, activated partial thromboplastin time, and platelet function analysis), and surgical factors (total blood loss, operation time, blood loss/10 minutes, number of fusion segments, posterolateral fusion/posterior lumbar interbody fusion, and virgin or revision surgery). POSEH developed more frequently in the patients in the study group than in those in the control group (14/98 patients, 14.3% vs. 3/176 patients, 1.7%, respectively; <italic>p</italic>=0.001; odds ratio, 17.1).</sec><sec><title>Conclusions</title>TCLH causes blood clot not only at the edge of damaged vessels but also at the site of extravascular blood. Excess TCLH matrix not associated with blood clot at the epidural space can enhance POSEH development because early clotted hematomas do not drain through suction drains.</sec>

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Chronic nontraumatic spinal epidural hematoma of the lumbar spine: MRI diagnosis

European Radiology ◽

10.1007/s003300000357 ◽

2000 ◽

Vol 10 (10) ◽

pp. 1602-1605 ◽

Cited By ~ 11

Author(s):

A. Vázquez-Barquero ◽

F. Abascal ◽

R. García-Valtuille ◽

J. I. Pinto ◽

F. J. Figols ◽

...

Keyword(s):

Lumbar Spine ◽

Epidural Hematoma ◽

Spinal Epidural Hematoma ◽

Mri Diagnosis ◽

Spinal Epidural ◽

Spine Mri

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Chronic Spinal Epidural Hematoma Presenting as Lumbar Stenosis: Clinical, Myelographic, and Computed Tomographic Features

Neurosurgery ◽

10.1227/00006123-198402000-00021 ◽

1984 ◽

Vol 14 (2) ◽

pp. 230-233 ◽

Cited By ~ 20

Author(s):

Daniel G. Nehls ◽

Andrew G. Shetter ◽

John A. Hodak ◽

John D. Waggener

Keyword(s):

Lumbar Spine ◽

Epidural Hematoma ◽

Major Trauma ◽

Spinal Epidural Hematoma ◽

Lumbar Stenosis ◽

Computed Tomographic ◽

Ct Findings ◽

History Of ◽

Spinal Epidural

Abstract The case of a patient with a chronic spinal epidural hematoma presenting as lumbar stenosis is described. There was no history of major trauma to the lumbar spine, anticoagulant use, or coagulopathy. The clinical, myelographic, and CT findings are presented and discussed.

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Postoperative spinal epidural hematoma in a biportal endoscopic spine surgery

Medicine ◽

10.1097/md.0000000000024685 ◽

2021 ◽

Vol 100 (6) ◽

pp. e24685

Author(s):

Dong Ki Ahn ◽

Jung Soo Lee ◽

Won Shik Shin ◽

San Kim ◽

Jin Jung

Keyword(s):

Spine Surgery ◽

Epidural Hematoma ◽

Spinal Epidural Hematoma ◽

Endoscopic Spine Surgery ◽

Spinal Epidural

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Neurologically Symptomatic Epidural Hematoma after Lumbar Spine Surgery - Comparative Study for Risk Factors -

Journal of Korean Society of Spine Surgery ◽

10.4184/jkss.2004.11.3.154 ◽

2004 ◽

Vol 11 (3) ◽

pp. 154 ◽

Cited By ~ 1

Author(s):

Dong Ki Ahn ◽

Song Lee ◽

Ki Woong Jung ◽

Soon Young Jeong ◽

Dae Jung Choi ◽

...

Keyword(s):

Risk Factors ◽

Lumbar Spine ◽

Comparative Study ◽

Spine Surgery ◽

Epidural Hematoma ◽

Lumbar Spine Surgery

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Effectiveness of Gelatin-Thrombin Matrix Sealants (Floseal®) on Postoperative Spinal Epidural Hematoma during Single-Level Lumbar Decompression Using Biportal Endoscopic Spine Surgery: Clinical and Magnetic Resonance Image Study

BioMed Research International ◽

10.1155/2020/4801641 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Ju-Eun Kim ◽

Hyun-Seung Yoo ◽

Dae-Jung Choi ◽

Eugene J. Park ◽

Jin-Ho Hwang ◽

...

Keyword(s):

Magnetic Resonance ◽

Incidence Rate ◽

Spine Surgery ◽

Epidural Hematoma ◽

Spinal Epidural Hematoma ◽

Endoscopic Spine Surgery ◽

Significant Difference ◽

Group A ◽

Group B ◽

Spinal Epidural

Background. Symptomatic postoperative spinal epidural hematoma (PSEH) is a devastating complication that could develop after lumbar decompression surgery. PSEH can also develop after biportal endoscopic spine surgery (BESS), one of the recently introduced minimally invasive spine surgery techniques. Gelatin-thrombin matrix sealant (GTMS) is commonly used to prevent PSEH. This study aimed at analyzing the clinical and radiological effects of GTMS use during BESS. Methods. A total of 206 patients with spinal stenosis who underwent decompression by BESS through a posterior interlaminar approach from October 2015 to September 2018 were enrolled in this study. Postoperative magnetic resonance imaging (MRI) was performed in all patients for evaluation of PSEH. Patients in whom GTMS was not used during surgery were assigned to Group A, and those in whom GTMS was used were classified as Group B. In the clinical evaluation, the visual analog scale (VAS) of the leg and back, Oswestry Disability Index (ODI), and modified MacNab criteria were used. The incidence rate and degree of dural compression of PSEH on postoperative MRI were measured. Results. The average age of the patients was 68.1±11.2 (42–89) years. The overall incidence rate of PSEH was 20.9% (43/206). The incidence rates in Groups A and B were 26.4% and 13.6%, respectively, showing a significant difference (p=0.023). The VAS-leg and ODI improvement was significantly different depending on the intraoperative use of GTMS. However, there was no statistically significant difference between the two groups in terms of the VAS-back improvement. Groups A and B showed “good” and “excellent” rates according to the modified MacNab criteria in 79.4% and 87.6% of patients, respectively, showing statistically significant difference (p=0.049). In Group A, two patients underwent revision surgery due to PSEH, while none in Group B had such event. Conclusion. Intraoperative use of GTMS during BESS may be related to reduction in the occurrence rate of PSEH. Specifically, patients with GTMS appliance showed marked decrease in the occurrence of PSEH and had better clinical outcomes.

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COMPARATIVE STUDY OF COMBINED SPINAL EPIDURALANESTHESIA VS GENERAL ANESTHESIA IN LOWER LUMBER SPINE SURGERY.

10.36106/ijsr/3209687 ◽

2021 ◽

pp. 34-36

Author(s):

Sagar Mukhopadhyay ◽

Shreyasi Chatterjee ◽

Kiran Kumar Mukhopadhyay

Keyword(s):

Lumbar Spine ◽

Comparative Study ◽

General Anesthesia ◽

Prone Position ◽

Spine Surgery ◽

Epidural Anesthesia ◽

Lumbar Spine Surgery ◽

Airway Compromise ◽

Combined Spinal Epidural Anesthesia ◽

Spinal Epidural

Either under general anesthesia or combined spinal ,epidural anesthesia lumbar spine surgery can be safely and successfully performed.However general anesthesia is commonly and widely used because of its faster onset of action.The advantages of using general anesthesia are patients comfort,satisfaction and the ability to carry out prolonged operations in the prone position without airway compromise.(1,2).

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