Asian Spine J.  2023 Feb;17(1):118-129. 10.31616/asj.2021.0366.

Remodeling of Epidural Fluid Hematoma after Uniportal Lumbar Endoscopic Unilateral Laminotomy with Bilateral Decompression: Comparative Clinical and Radiological Outcomes with a Minimum Follow-up of 2 Years

• Wu PH
• Kim HS
• Grasso G
• An JW
• Kim M
• Lee I
• Park JS
• Lee JH
• Kang S
• Lee J
• Yi Y
• Lee JH
• Park JH
• Lim JH
• Jang IT

• KMID: 2539749
• DOI: http://doi.org/10.31616/asj.2021.0366

Abstract

Study Design: Retrospective cohort study. Purpose: To evaluate the clinical and radiological effects of epidural fluid hematoma in the medium term after lumbar endoscopic decompression. Overview of Literature: There is limited literature comparing the effect of postoperative epidural fluid hematoma after uniportal endoscopic decompression.
Methods
Magnetic resonance imaging (MRI) and clinical evaluation were performed for patients with single-level uniportal endoscopic lumbar decompression with a minimum follow-up of 2 years.
Results
A total of 126 patients were recruited with a minimum follow-up of 26 months. The incidence of epidural fluid hematoma was 27%. Postoperative MRI revealed a significant improvement in the postoperative dura sac area at postoperative day 1 and at the upper endplate at 6 months in the hematoma cohort (39.69±15.72 and 26.89±16.58 mm²) as compared with the nonhematoma cohort (48.92±21.36 and 35.1±20.44 mm²), respectively (p <0.05); and at the lower endplate on postoperative 1 day in the hematoma cohort (51.18±24.69 mm²) compared to the nonhematoma cohort (63.91±27.92 mm²) (p <0.05). No significant difference was observed in the dura sac area at postoperative 1 year in both cohorts. The hematoma cohort had statistically significant higher postoperative 1-week Visual Analog Scale (VAS; 3.32±0.68) pain and Oswestry Disability Index (ODI; 32.65±5.56) scores than the nonhematoma cohort (2.99±0.50 and 30.02±4.84, respectively; p <0.05). No significant difference was found at the final follow-up VAS, ODI, and MRI dura sac area.
Conclusions
Epidural fluid hematoma is a common early postoperative MRI finding in lumbar endoscopic unilateral laminotomy with bilateral decompression. Conservative management is the preferred treatment option for patients who do not have a neurological deficit. Symptoms last only a few days and are self-limiting. A common endpoint is a remodeled fluid hematoma and the subsequent expansion of the dura sac area.

Keyword

Spinal epidural hematoma; Postoperative complications; Spinal stenosis; Minimally invasive surgical procedures; Spine; Endoscopic spine surgery; Lumbar endoscopic unilateral laminotomy for bilateral decompression