Early Decompressive Surgery for Compressive Neuropathy by Hematoma after Posterior Spinal Decompressive Surgery

Yong-Min Kim; Choong-Hee Won; Eui-Seong Choi; Byung-Ki Cho

doi:10.4184/jkss.2002.9.4.347

Journal List > J Korean Soc Spine Surg > v.9(4) > 1036038

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Kim, Won, Choi, and Cho: Early Decompressive Surgery for Compressive Neuropathy by Hematoma after Posterior Spinal Decompressive Surgery

Original Article

Journal of Korean Spine Surg 2002;9(4):347-355.

Published online: 12 February 2002

DOI: https://doi.org/10.4184/jkss.2002.9.4.347

Early Decompressive Surgery for Compressive Neuropathy by Hematoma after Posterior Spinal Decompressive Surgery

Yong-Min Kim, M.D., Choong-Hee Won, M.D., Eui-Seong Choi, M.D., Byung-Ki Cho, M.D.

Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea

Address reprint requests to Yong-Min Kim, M.D. Department of Orthopaedic Surgery, Chungbuk National University Hospital #62, Gaesin-dong, Cheongju, Chungbuk 360-711, Korea Tel : 82-43-269-6077, Fax : 82-43-274-8719, E-mail : ymkim@med.chungbuk.ac.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

A retrospective analysis was performed to identify the diagnostic and therapeutic factors related to postoperative compressive neuropathy by hematoma after posterior spinal decompressive surgery.

Objectives

To document by analysis the clinical course of postoperative compressive neuropathy by hematoma, the efficacy of early surgical decompression, and to recommend methods of prevention.

Summary of Literature Review

Various diagnostic and treatment modalities have been applied to postoperative compressive neuropathy after spinal surgery. However, the timing of surgical decompression remains controversial.

Materials and Methods

Five cases of postoperative compressive neuropathy after posterior spinal decompressive surgery, which occurred from May 1996 to May 2000, were investigated in terms of causes, clinical courses, and management profiles after early surgical decompression, and final outcome.

Results

Five cases (2.14%) among 234 patients were managed by re- decompression including the evacuation of hematoma. Four cases, which had been managed by earlier surgical decompression showed neurologic improvement after 2 postoperative weeks, and achieved favorable clinical results without grave neurologic sequelae. However, in one case, in which surgical decompression had been delayed, weakness of the peroneii remained.

Conclusion

Early evacuation of hematoma achieved a more favorable result than a delayed operation. Early diagnosis and prompt surgical decompression is recommended to reduce neurologic sequelae.

Keywords: Early decompressive surgery, Compressive neuropathy, Hematoma

REFERENCES

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Fig. 1.

Removed Hemo-vac shows malfunction of suction lines due to occlusion by blood clot

Fig. 2.

Immediate myelogram shows broad filling defect at main laminectomy site

Fig. 3.

Abundant blood clots compressing dura were evacuated within 24 hours after initial decompressive surgery

Fig. 4.

Right L5 & S1 roots were not visualized in myelogram performed on 11th postoperative day (white arrows)

Fig. 5.

MRI performed on postoperative fourth month shows severe scar adhesion by granulation of hematoma at right L5 root (white arrow)

Table 1.

Profile of Compressive Neuropathy by Hematoma after Spine Surgery

Case	Sex/Age	Spine problem	Level of decompressive op.^§	Level of compressive neuropathy	Interval to reoperation
1	F/65	Spinal stenosis	L4-S1	Rt. L5, S1 root	24hr
2	M/38	L2 bursting Fx.^∗	L2	Cauda equina	20hr
3	F/35	Traumatic disc rupture	L3-4	Cauda equina	16hr
4	F/24	HIVD^‡	L4-5, L5-S1	Rt. L5, S1 root	8month
5	M/51	CSM^†	C3-7	Lower cervical cord & root	24hr

^∗ Fx: fracture

^† CSM: cervical spondylotic myelopathy,

^‡ HIVD: herniated intervertebral disc,

^§ op: operation

Table 2.

Profile of Postoperative Neurologic Signs of Five Cases

Case	Motor signs (Rt. / Lt.)	Sciatica	Sensory change	D.T.R^∗		Anal reflex	Ankle clonus
Case	Motor signs (Rt. / Lt.)	Sciatica	Sensory change	Knee	Ankle	Anal reflex	Ankle clonus
1	TA^† 2+ / 4+ EPH^‡ 3 / 4+ Peronei 3 / 4+	Rt.	Rt. L5 & S1 area ↓ Perianal sense (++)	+/+	+/+	++	-/-
2	TA 0 / 0 EPH 0 / 0 Peronei 0 / 0	Both	Both L3-S1 area ↓ Perianal sense (±)	-/-	-/-	±	-/-
3	TA 2 / 0 EPH 0 / 0 Peronei 0 / 0	Both	Both L4-S1 area ↓ Perianal sense (-)	-/-	-/-	-	-/-
4	TA 3+ / 5 EPH 2 / 5 Peronei 1+ / 5	Rt.	Rt. L5 & S1 area ↓ Perianal sense (++)	+/+	-/+	++	-/-
5	Finger flexor 3 / 3 Finger abductor 2 / 3	-	Both C5-C8 area ↓ Perianal sense (++)	++/++ Biceps jerk Triceps jerk	++/+++++++	++	-/-

^∗ D.T.R: deep tendon reflex

^† TA: tibialis anterior muscle,

^‡ EPH: extensor hallus longus muscle

Table 3.

Profile of Neurologic Signs at Final Follow-up of Five Cases

Case	Follow-up period	Motor signs (Rt. / Lt.)	Sensory signs	D.T.R^∗		Final complaint
Case	Follow-up period	Motor signs (Rt. / Lt.)	Sensory signs	Knee	Ankle	Final complaint
1	PO^§14 month	TA^† 4+ / 5 EPH^‡ 4+ / 5 Peronei 5 / 5	symmetric intact Perianal sense (++)	+/++	++/++	Low back pain
2	PO 22 month	TA 4+ / 5 EPH 4+ / 5 Peronei 4+ / 5	Rt. S1 area ↓ Perianal sense (++)	+/++	+/++	Both L/E^∫ weakness
3	PO 17 month	TA 5 / 4+ EPH 5 / 5 Peronei 5 / 5	symmetric intact Perianal sense (++)	++/++	+/+	Low back pain
4	PO 16 month	TA 3+ / 5 EPH 4- / 5 Peronei 3- / 5	Rt. L5 area ↓ Perianal sense (++)	+/++	+/++	Rt. foot drop
5	PO 12 month	Finger flexor 5 / 5 Finger abductor 5 / 5	Both C6-C7 area ↓ Perianal sense (++)	++/++ Biceps jerk Triceps jerk	++/++++++	Both hand tingling sense

^∗ D.T.R: deep tendon reflex

^† TA: tibialis anterior muscle,

^‡ EPH: extensor hallus longucis muscle,

^§ PO: postoperative, extremity

^∫ L/E: lower

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