Postoperative spinal epidural hematoma: a systematic review.
Michael P Glotzbecker1, Christopher M Bono, Kirkham B Wood
1Harvard Combined Orthopaedic Residency Program and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
Spine
|May 1, 2010
Summary
The incidence of clinically relevant epidural hematoma after spinal surgery is rare, ranging from 0% to 1%. This low incidence makes studying risk factors difficult, and more data is needed to define the safety of chemoprophylaxis.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Anesthesiology
Background:
- Thromboembolic prophylaxis (chemoprophylaxis) following spinal surgery presents a dilemma due to unclear indications and timing.
- Spine surgery patients face risks of thromboembolic disease (DVT/PE) and symptomatic postoperative epidural hematoma.
- The incidence of epidural hematoma is not well-established, creating uncertainty in risk-benefit assessments for chemoprophylaxis.
Purpose of the Study:
- To determine the incidence of epidural hematoma in patients undergoing spinal surgery.
- To evaluate the impact of chemical thromboprophylaxis on the risk of developing epidural hematoma.
Main Methods:
- A systematic literature review of MEDLINE was conducted using keywords 'epidural hematoma' and 'spinal' or 'spine surgery'.
- Studies were included if they reported the incidence of clinically significant epidural hematoma in patients post-spinal surgery.
- Data extraction and analysis focused on incidences of epidural hematoma resulting in new neurologic deficits.
Main Results:
- Sixteen studies were eligible for review out of 493 identified abstracts.
- Reported incidences of epidural hematoma ranged from 0% to 0.7% with chemical anticoagulation and 0% to 1% overall.
- No study reported an incidence greater than 1% for clinically relevant epidural hematoma.
Conclusions:
- Symptomatic postoperative epidural hematoma, though feared, is a rare complication (0-1% incidence).
- The low incidence complicates risk factor analysis and definitive assessment of chemoprophylaxis safety.
- Insufficient data exists to precisely define the safety of postoperative chemoprophylaxis; however, therapeutic heparin may increase bleeding risks.
