Yonsei Med J.  2006 Jun;47(3):326-332. 10.3349/ymj.2006.47.3.326.

Postoperative Spinal Epidural Hematoma: Risk Factor and Clinical Outcome

• Yi S
• Yoon DH
• Kim KN
• Kim SH
• Shin HC

• KMID: 1715850
• DOI: http://doi.org/10.3349/ymj.2006.47.3.326

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.

Keyword

Clinical outcome; risk factor; postoperative; spinal epidural hematoma; spine surgery

MeSH Terms

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

Figure

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  Fig. 1 Dorsally located epidural hematoma in thoracic spine (Patient 9).The signal characteristics of the epidural hematoma lesion included isointense or increased signal intensity on T1-weighted image, heterogenous intensity on T2-weighted images. The sagittal and parasagittal images usually show a convex lens-shaped lesion.

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  Fig. 2 Ventrolaterally located epidural hematoma extending from C3 to T3 in patient 4.

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  Fig. 3 Patient 2 showed localized epidural hematoma mixed with absorbable hemostats, Surgicel compressing cervical cord ventrally at the level of initial surgery.

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  Fig. 4 Slightly increased signal on T1-weighted images, high signal on T2-weighted images in acute epidural hematoma case. Patient 3 showed extensive dorsally located SEH although minimal invasive procedure (epidural block on C3, 4, 5) had been performed.

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