Symptomatic Postoperative Spinal Epidural Hematoma after Spinal Decompression Surgery: Prevalence, Risk Factors, and...

Area of Science:

• Neurosurgery
• Spinal Surgery
• Neurology

Background:

• Postoperative spinal epidural hematoma (pSEH) is a rare but serious complication following spinal decompression surgery.
• Delayed diagnosis and treatment of pSEH can lead to significant neurological impairment.

Purpose of the Study:

• To analyze the prevalence, risk factors, and functional recovery associated with pSEH.
• To identify predictors of complete recovery and poor neurologic outcomes in patients with pSEH.

Main Methods:

• Retrospective review of 6,024 spinal decompression surgeries over 15 years.
• Identified 42 patients with pSEH and matched them with 126 controls.
• Analyzed demographic, clinical, surgical, and radiographic data using logistic regression models.

Main Results:

• The prevalence of pSEH was 0.69%, with varying rates across cervical, thoracic, and lumbar spine surgeries.
• Independent risk factors for pSEH included anticoagulant use, abnormal preoperative coagulation, and cigarette smoking.
• Pain as the sole symptom predicted complete recovery, while paraplegia indicated a higher risk of poor outcome.

Conclusions:

• The identified prevalence of pSEH is lower than previously reported.
• Anticoagulation, coagulation abnormalities, and smoking are significant risk factors for pSEH.
• Timely hematoma evacuation is crucial for favorable functional outcomes in symptomatic pSEH.