Postoperative Spinal Epidural Hematoma: Risk Factor and Clinical Outcome.
10.3349/ymj.2006.47.3.326
- Author:
Seong YI
1
;
Do Heum YOON
;
Keung Nyun KIM
;
Sang Hyun KIM
;
Hyun Chul SHIN
Author Information
1. Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea. imdrshin@yumc.yonsei.ac.kr
- Publication Type:Original Article
- Keywords:
Clinical outcome;
risk factor;
postoperative;
spinal epidural hematoma;
spine surgery
- MeSH:
Treatment Outcome;
Spinal Diseases/*surgery;
Risk Factors;
Retrospective Studies;
Postoperative Complications/diagnosis/*epidemiology;
Middle Aged;
Male;
Humans;
Hematoma, Epidural, Spinal/diagnosis/*epidemiology/*etiology;
Female;
Aged;
Adult
- From:Yonsei Medical Journal
2006;47(3):326-332
- CountryRepublic of Korea
- Language:English
-
Abstract:
We report a series of epidural hematomas which cause neurologic deterioration after spinal surgery, and have taken risk factors and prognostic factors into consideration. We retrospectively reviewed the database of 3720 cases of spine operation in a single institute over 7 years (1998 April-2005 July). Nine patients who demonstrated neurologic deterioration after surgery and required surgical decompression were identified. Factors postulated to increase the postoperative epidural hematoma and to improve neurologic outcome were investigated. The incidence of postoperative epidural hematoma was 0.24%. Operation sites were cervical 3 cases, thoracic 2 cases, and lumbar 4 cases. Their original diagnoses were tumor 3 cases, cervical stenosis 2 cases, lumbar stenosis 3 cases and herniated lumbar disc 1case. The symptoms of epidural hematomas were neurologic deterioration and pain. After decompression, clinical outcome revealed complete recovery in 3 cases (33.3%), incomplete recovery in 5 cases (55.6%) and no change in 1 case (11.1%). Factors increasing the risk of postoperative epidural hematoma were coagulopathy from medical illness or anticoagulation therapy (4 cases, 44.4%) and highly vascularized tumor (3 cases, 33.3%). The time interval to evacuation of complete recovery group (29.3 hours) was shorter than incomplete recovery group (66.3 hours). Patients with coagulopathy and highly vascularized tumor were more vulnerable to spinal epidural hematoma. The postoperative outcome was related to the preoperative neurological deficit and the time interval to the decompression.
