Postoperative Spinal Epidural Hematoma: Risk Factor and Clinical Outcome
Reads0
Chats0
TLDR
The postoperative outcome was related to the preoperative neurological deficit and the time interval to the decompression, and patients with coagulopathy and highly vascularized tumor were more vulnerable to spinal epidural hematoma.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 1 case. 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.read more
Citations
More filters
Journal ArticleDOI
Postoperative spinal epidural hematoma: a systematic review.
TL;DR: The catastrophic morbidity of a symptomatic postoperative epidural hematoma remains a substantial disincentive to start chemopropylaxis after spinal surgery, and there is insufficient published data available to precisely define the safety of postoperative chemoprophylaxis.
Journal ArticleDOI
Postoperative spinal epidural hematoma (SEH): incidence, risk factors, onset, and management.
TL;DR: It is suggested that earlier surgical intervention may result in greater neurological recovery after spinal surgery, and alcohol consumption greater than 10 units a week, multilevel procedure, and previous spinal surgery were identified as risk factors for developing symptomatic SEH.
Journal ArticleDOI
Surgeon Practices Regarding Postoperative Thromboembolic Prophylaxis After High-Risk Spinal Surgery
Michael P. Glotzbecker,Christopher M. Bono,Mitchel B. Harris,Gregory W. Brick,Robert F. Heary,Kirkham B. Wood +5 more
TL;DR: The wide variability of surgeons' practices regarding thromboembolic prophylaxis in high-risk spine surgery patients is demonstrated, likely a symptom of the glaring paucity of scientific evidence concerning the risk for symptomatic epidural hematoma, DVT, and PE and the efficacy and safety of specific chemoprophylactic protocols after spine surgery.
Journal ArticleDOI
Decreased incidence of venous thromboembolism after spine surgery with early multimodal prophylaxis: Clinical article.
TL;DR: At a high-volume tertiary center, an aggressive protocol for early VTE prophylaxis after spine surgery decreases VTE incidence without increasing morbidity and compared favorably to the published literature.
Journal ArticleDOI
Low-molecular-weight heparin prophylaxis 24 to 36 hours after degenerative spine surgery: risk of hemorrhage and venous thromboembolism.
TL;DR: LMWH prophylaxis seems to carry a very low hemorrhage risk when started 24 to 36 hours after degenerative spine surgery, and larger, prospective studies are needed to assess the safety of early delayed LMWH administration more definitively.
References
More filters
Journal ArticleDOI
Anticoagulants and spinal-epidural anesthesia.
Journal ArticleDOI
Surgical management of spinal epidural hematoma: relationship between surgical timing and neurological outcome
Michael T. Lawton,Randall W. Porter,Joseph E. Heiserman,Ronald Jacobowitz,Volker K.H. Sonntag,Curtis A. Dickman +5 more
TL;DR: This large series of SEH demonstrates that rapid diagnosis and emergency surgical treatment maximize neurological recovery, however, patients with complete neurological lesions or long-standing compression can improve substantially with surgery.
Journal ArticleDOI
The spontaneous spinal epidural hematoma. A study of the etiology.
Rob J. M. Groen,Hans Ponssen +1 more
TL;DR: The authors have the opinion that the posterior internal vertebral venous plexus plays an important part in the etiology of the SSEH.
Journal ArticleDOI
Preoperative neurological status in predicting surgical outcome of spinal epidural hematomas
TL;DR: The postoperative progress of 3 patients with spinal epidural hemorrhage, but without spinal fracture or dislocation, is presented and the absence of motor or sensorimotor functions preoperatively does not necessarily indicate a poor prognosis.
Journal ArticleDOI
Pathophysiology of spinal cord injury. Recovery after immediate and delayed decompression
TL;DR: The dogs that had immediate decompression or decompression after one hour of compression recovered the ability to walk as well as control of the bowel and bladder, and the somatosensory evoked potentials improved an average of 85 and 72 per cent, respectively, however, when compression lasted six hours or more, there was no neurological recovery and there was progressive necrosis of the spinal cord.