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Updated: Jul 8, 2026

Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device

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Postoperative lumbar epidural hematoma: does size really matter?

Mark J Sokolowski¹, Timothy A Garvey, John Perl

¹Trinity Orthopaedics, SC, Oak Park, IL, USA.

|January 1, 2008

Summary

A new measure, the critical ratio, effectively predicts postoperative symptoms after lumbar surgery. This ratio, derived from MRI scans, shows greater correlation with symptom severity than simple hematoma volume.

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Area of Science:

Neurosurgery
Radiology
Medical Imaging

Background:

Postoperative epidural hematomas after lumbar surgery are common.
Symptomatic progression involves pain and neurological deficits.
Factors differentiating symptomatic from asymptomatic patients are unclear.
MRI measures of hematoma size and mass effect may correlate with symptoms.

Purpose of the Study:

To compare direct hematoma volume measurements with a novel metric, the critical ratio, for assessing thecal sac compression.
To determine the correlation between the critical ratio and postoperative symptoms following lumbar decompression.

Main Methods:

Prospective study comparing prospectively collected data with retrospective data.
Three patient groups: asymptomatic (n=57), severe pain (n=12), and cauda equina syndrome (n=5).
MRI analysis to calculate hematoma volume and the critical ratio (postoperative to preoperative thecal sac cross-sectional area ratio).

Main Results:

The critical ratio significantly differed among all three patient groups (P < 0.05).
Mean critical ratios were 0.8 (asymptomatic), 0.5 (painful), and 0.2 (cauda equina syndrome).
Hematoma volume did not significantly differentiate the groups.

Conclusions:

The critical ratio is a more accurate predictor of postoperative symptoms than hematoma volume.
Increased thecal sac compression, as indicated by a lower critical ratio, correlates with symptom severity.
The critical ratio offers a valuable tool for interpreting postoperative lumbar MRI scans.