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Abstract
Objectives
To verify the risk factors, distinction of symptomatic and prognosis of the postoperative neurologically symptomatic epidural hematoma at the lumbar region.
Summery of Literature Review
Even though an epidural hematoma is one of the well known causes of postoperative neurological complications, the rarity makes it difficult to account for the causes of this phenomenon.
Material and Methods
Eight patients who had a proven neurologically symptomatic epidural hematoma were reviewed. We analyzed the degrees of neurologic recovery according to the initial degree of the neurological deficit and the time to the hematoma evacuation. Two hundred four patients who underwent a lumbar operation during the months contemporary with the occurrence of each cases (ed note: I do not know what this means.) by the same surgeon, were selected as the control group.
Results
A mong the 2,951 patients, 8 patients (0.027%) developed such complication. Using a simple logistic regression test, an increased amount of bleeding, a prolonged operation time, a decreased platelet count before and after surgery, hypertension and previous cardiovascular disease were recognized as significant risk factors, but the statistical significance was lost in all factors by multiple logistic regression test. There was no significant correlation between the neurological recovery and initial neurological deficit or retardation before the hematoma evacuation.
Conclusions
Compressive epidural hematoma following lumbar spine surgery can cause serious neurological symptom. Significant risk factors were not demonstrated. Therefore, it can be developed in ordinary patients. All cases developed neurological symptom within the first 8 hours after surgery. A ccordingly, cautious observation of the neurological changes at early period is important for detecting and treating such complication. The neurologically symptomatic epidural hematoma should be evacuat-ed even in delayed cases, because neurological recovery can be expected.
REFERENCES
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Figures and Tables%
Fig. 1.
T2 weighted sagittal (A) and axial (B) MR images which show large sized heterogenous high signal intensity epidural mass which is compressing cauda equina and bulging out back muscles.
Fig. 2.
Intraoperative photograph which shows large sized hematoma (arrow) at previous decompression site.
Table 1.
Demographie data of the study group
| Case | Age (year) | Sex | Diagnosis | Operation methods | Operation segments | Symptom Onset | Medical problems | Time to evacuation | Frankel grade | |
|---|---|---|---|---|---|---|---|---|---|---|
| Initial | Last FU* | |||||||||
| 1 | 66 | Female | Stenosis | PLF† | L45S1 | 3 hours | HTN‡ CHD§ | 8 hours | A | E |
| 2 | 60 | Female | Stenosis | Decompression | L45 | 3 hours | - | 5 hours | С | E |
| 3 | 64 | Female | Stenosis | PLF† | L5S1 | immediately | HTN‡ | observation | D | D |
| 4 | 46 | Female | Listhesis, lytic | PLF† | L345S1 | immediately | Liver disease | 8 days | С | D |
| 5 | 57 | Female | Stenosis | PLIF‖ | L345 | 3 hours | HTN‡ CHD§ | 2 days | С | E |
| 6 | 46 | Female | HNP‖, recurred | PLF† | L45 | 8 hours | - | 3 days | С | E |
| 7 | 62 | Male | Stenosis | PLF† | L45 | 3 hours | HTN‡ | 8 hours | с | D |
| 8 | 50 | Female | Stenosis | PLIF‖ | L45 | 3 hours | - | 1 days | D | E |
Table 2.
Preoperative diagnosis of control group
| Diagnosis | Control group |
|---|---|
| Stenosis | 100 |
| HNP* | 64 |
| Listhesis, lytic | 17 |
| HNP, instability | 6 |
| Listhesis, degenerative | 5 |
| Peudoarthrosis | 5 |
| Spondylitis | 2 |
| HNP, recurred | 1 |
| Junctional problem | 1 |
| Spondylosis | 1 |
| Total | 204 |
Table 3.
Comparative statistics
| Factors | Study group | Control group |
|---|---|---|
| Demographic factors | ||
| Age (av.*) | 56.4± 8.0 years | 50.8± 13.4 years |
| Sex (Male/Female) | 1 / 7 | 70 / 134 |
| Operative factors | ||
| Number of segment (av.*) | 1.5± 0.8 | 1.3± 0.6 |
| Blood loss (av.*) | 1,575± 968 ml | 922± 552 ml |
| Operation time (av.*) | 261.3± 96.8 min | 168.0± 78.5 min |
| Hemovac (with/without) | 7 / 1 | 171 / 33 |
| Instrumentation (with/without) | 7 / 1 | 58 / 146 |
| Coagulation factors | ||
| Preoperative platelet count (av.*) | 219,875± 48,516 /μl | 260,152± 51,151 /μl |
| Postoperative platelet count (av.*) | 149,250± 52,817 /μl | 193,103± 41,536 /μl |
| Bleeding time (av.*) | 1.9± 1.1 min | 1.5± 0.6 min |
| Coagulation time (av.*) | 5.4± 1.2 min | 5.4± 0.9 min |
| Prothrombin time (av.*) | 10.1± 1.1 sec | 11.2± 2.9 sec |
| Partial prothrombin time (av.*) | 34.3± 7.4 sec | 35.9± 5.9 sec |
| Medical factors (with/without) | ||
| Hypertension | 4 / 4 | 26 / 178 |
| Coronary heart disease | 2 / 6 | 7 / 197 |
| Liver disease | 1 / 7 | 33 / 171 |
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