Postoperative spinal epidural hematoma after microscopic lumbar decompression: a prospective magnetic resonance
Hitesh N Modi1, Dong Yeob Lee, Sang-Ho Lee
1Department of Orthopedic Surgery, Wooridul Spine Hospital, 47-4 Chungdam-dong, Gangnam-gu, Seoul, Korea.
Study Design:
A prospective case series.
Objective:
To prospectively analyze the incidence, characteristics, clinical outcomes, and risk factors of postoperative spinal epidural hematoma (SEH) after microscopic lumbar decompression using magnetic resonance imaging (MRI).
Summary Of Background Data:
Studies prospectively focusing on postoperative SEH after microscopic lumbar decompression alone are rare.
Methods:
Eighty-nine patients who underwent microscopic lumbar decompressive surgery for herniated disc and/or stenosis between January 2007 and June 2007 were prospectively followed. Decompression was carried out using unilateral or bilateral laminotomy in all patients. Postoperative MRI was taken at 24 hours after surgery in all patients. Using operative report, chart, and MRI, the incidence, characteristics, and risk factors of postoperative SEH were evaluated. Clinical outcomes were evaluated 2 years after surgery using Visual Analogue Scale score and Oswestry Disability Index.
Results:
Postoperative SEH developed in 13 patients (14.6%). There were 5 males and 8 females. The mean age of these patients was 57.1 years. Postoperative SEH occurred at the index level in 6 cases, and at the index level with extension toward non-decompressed adjacent levels in 7 cases. Eleven patients were asymptomatic and 2 patients complained of leg pain and/or mild weakness. No patients underwent revision surgery owing to postoperative SEH. There was no significant difference in improvements of Visual Analogue Scale and ODI scores, and clinical success rate between patients with and without SEH. Patient's age 50 years old or more was the only significant risk factor for the development of postoperative SEH (P=0.024; odds ratio=5.12).
Conclusions:
The incidence of postoperative SEH after microscopic lumbar decompressive surgery was 14.6%. Postoperative SEH did not delay clinical improvements. Age 50 years old or more was strongly associated with the development of postoperative SEH.
Insights
Postoperative spinal epidural hematoma (SEH) occurred in 14.6% of patients after microscopic lumbar decompression. Older age (50+) was a significant risk factor, but SEH did not impede recovery.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Radiology
Background:
- Postoperative spinal epidural hematoma (SEH) following microscopic lumbar decompression is uncommon.
- Prospective studies analyzing SEH after this specific procedure are scarce.
Purpose of the Study:
- To determine the incidence and characteristics of SEH after microscopic lumbar decompression.
- To identify risk factors and evaluate clinical outcomes associated with SEH.
Main Methods:
- Prospective case series of 89 patients undergoing microscopic lumbar decompression for disc herniation or stenosis.
- Postoperative MRI at 24 hours to detect SEH; clinical outcomes assessed at 2 years using VAS and ODI.
Main Results:
- SEH incidence was 14.6% (13/89 patients).
- Age 50 or older was the sole significant risk factor (OR=5.12).
- Most SEH cases were asymptomatic; no revision surgeries were needed, and clinical outcomes were similar to patients without SEH.
Conclusions:
- Microscopic lumbar decompression has a 14.6% SEH incidence.
- SEH does not negatively impact short-term clinical outcomes.
- Advanced age is a key risk factor for developing SEH.
