Risk factors of postoperative spinal epidural hematoma after transforaminal lumbar interbody fusion surgery

To assess the incidence and analyze the risk factors of postoperative spinal epidural hematoma (SEH) after transforaminal lumbar interbody fusion (TLIF) surgery, in order to provide a solution for reducing the occurrence of postoperative SEH after TLIF.

A total of 3717 patients who were performed TLIF surgery in the Orthopedics department of our hospital from January 2010 to March 2020 were included. Patients who had reoperations due to postoperative SEH were selected as the SEH group. The control group was randomly selected from patients without reoperations with the ratio of 3:1 compared to the SEH group. The basic information, preoperative examination and surgical information of the patients were collected through the hospital medical record system, and the statistics were processed through SPSS 22.0 software.

(1) Among the 3717 patients who underwent TLIF surgery in our hospital in the past 10 years, 46 had secondary surgeries, with a total incidence of 1.24%. 12 cases had secondary surgeries due to postoperative SEH, with an incidence of 0.35%. (2) Univariate analysis identified eight factors potentially associated with risk for postoperative SEH, including older age, longer thrombin time (TT), higher level of alkaline phosphatase (ALP), higher number of fusion segments, revision surgery, having received blood transfusion, using of more than one gelatin sponge or using of styptic powder in the surgery, longer operation time and more blood loss in the surgery (P<0.05). (3) On multivariate analysis, three factors were identified as independent risk factors, which include revision surgery (P=0.021, OR=7.667), longer TT (P=0.027, OR=2.586) and using of more than one gelatin sponge or using of styptic powder in the surgery (P=0.012, OR=9.000).

Revision surgery (P=0.021, OR=7.667), longer TT (P=0.027, OR=2.586) and using of more than one gelatin sponge or using of styptic powder in the surgery were independent risk factors for postoperative SEH after TLIF.