Postoperative spinal epidural hematoma (SEH): incidence,risk factors,onset, and management |
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| Authors: | Amir R. Amiri Ioannis P. Fouyas Suzie Cro Adrian T.H. Casey |
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| Affiliation: | 1. Spinal Injury Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom;2. Department of Clinical Neurosciences, Western General Hospital, Crewe Rd, Edinburgh, EH4 2XU, United Kingdom;3. Medical Research Council Clinical Trial Unit, Aviation House, 125 Kingsway, London, WC2B 6NH, United Kingdom;1. Division of Endovascular Neurosurgery and Interventional Neuroradiology, Department of Neurosurgery, Brigham and Women''s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA;2. Department of Orthopaedics, Brigham and Women''s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA;3. Department of Neuroradiology, Brigham and Women''s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA;1. Department of Neurology-Pediatric Neurology, Antwerp University Hospital (UZA), University of Antwerp, Wilrijkstraat 10, B-2650 Edegem, Belgium;2. Department of Pediatrics, Antwerp University Hospital, University of Antwerp, Belgium;3. Pediatric Critical Care Unit, Antwerp University Hospital, University of Antwerp, Belgium;4. Department of Neurosurgery, Antwerp University Hospital University of Antwerp, Belgium;5. Department of Radiology, Antwerp University Hospital, University of Antwerp, Belgium;6. Department of Pediatrics, KLINA Regional Hospital, Brasschaat, Belgium;1. Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Japan;2. Department of Orthopedic Surgery, Osaka Medical College, Japan;3. Department of Orthopaedic Surgery, Faculty of Medicine, Fukushima Medical University, School of Medicine, Japan;4. Spine Center, Ehime University Hospital, Japan;5. Department of Orthopaedic Surgery, Tohoku University School of Medicine, Japan;6. Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Japan;7. Department of Orthopaedic Surgery, Graduate School of Medical Science Kanazawa University, Japan;8. Department of Orthopaedic Surgery, Hyogo Rehabilitation Center Hospital, Japan;1. Division of Neurosurgery, Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia;2. Department of Orthopedic Surgery, McGill University, Montreal, Quebec, Canada |
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| Abstract: | Background contextSpinal epidural hematoma (SEH) is a rare, yet potentially devastating complication of spinal surgery. There is limited evidence available regarding the risk factors and timing for development of symptomatic SEH after spinal surgery.PurposeTo assess the incidence, risk factors, time of the onset, and effect of early evacuation of symptomatic SEH after spinal surgery.Study designMulticenter case control study.Patient sampleAll patients who underwent open spinal surgery between October 1, 1999, and September 30, 2006, at the National Hospital For Neurology and Neurosurgery (NHNN) and the Wellington Hospital (WH) were reviewed.Outcome measuresFrankel grade.MethodsPatients who developed SEH and underwent evacuation of the hematoma were identified. Two controls per case were selected. Each control had undergone a procedure with similar complexity, at the same section of the spine, at the same hospital, and under the same surgeon within 6 months of the initial operation.ResultsA total of 4,568 open spinal operations were performed at NHNN and WH. After spinal surgery, 0.22% of patients developed symptomatic SEH. Alcohol greater than 10 units a week (p=.031), previous spinal surgery (p=.007), and multilevel procedures (p=.002) were shown to be risk factors. Initial symptoms of SEH presented after a median time of 2.7 hours (interquartile range [IQR], 1.1–126.1). Patients who had evacuation surgery within 6 hours of the onset of initial symptoms improved a median of 2 (IQR, 1.0–3.0) Frankel grades, and those who had surgery more than 6 hours after the onset of symptoms improved 1.0 (IQR, 0.0–1.5) Frankel grade, p=.379.ConclusionsSymptomatic postoperative SEH is rare, occurring in 0.22% of cases. Alcohol consumption greater than 10 units a week, multilevel procedure, and previous spinal surgery were identified as risk factors for developing SEH. Spinal epidural hematoma often presents early in the postoperative period, highlighting the importance of close patient monitoring within the first 4 hours after surgery. This study suggests that earlier surgical intervention may result in greater neurological recovery. |
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