Risk Factors for Incidence of Postoperative Spinal Epidural Hematoma Following Multilevel Microendoscopic Laminectomy
Hirofumi Bekki1, Takeshi Arizono1, Akihiko Inokuchi1
1Department of Orthopaedic Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, Japan.
Introduction:
Due to the narrow portal of entry, microendoscopic laminectomy (MEL) is associated with a risk of postoperative spinal epidural hematoma (POSEH). This risk might be higher when performing multiple-level (m-) MEL. The purpose of this study is to clarify the incidence rate of POSEH following single-level (s-) and m-MEL by each interlaminar level and identify the risk factors for POSEH following m-MEL.
Methods:
A total of 379 patients underwent MEL of the lumbar spine (s-MEL, n=141; m-MEL, n=238). We determined the incidence of POSEH following s-MEL and m-MEL by each interlaminar level. For m-MEL, we clarified the correlation between POSEH and possible risk factors, such as operative findings, the sequence of operated interlaminar levels, and the preoperative cross-sectional dural area (CSA) on magnetic resonance imaging.
Results:
The incidence rate at L2/3 was significantly higher than that at L3/4 and L4/5. Patients who underwent L2/3 decompression at the end of the procedure showed a higher incidence of POSEH at the L2/3 level. Preoperative spinal stenosis was associated with POSEH at the L2/3 level, and CSA of 56 mm2 was a predictive factor for POSEH. Logistic regression analysis revealed that both were significant risk factors.
Conclusions:
In patients undergoing m-MEL, the incidence of POSEH is highest at the L2/3 level, and treatment of the L2/3 level at the end of the procedure and the presence of spinal stenosis are risk factors for POSEH.
Insights
Microendoscopic laminectomy (MEL) carries a risk of spinal epidural hematoma (SEH). The L2/3 level is most affected in multiple-level MEL, with spinal stenosis and late-stage L2/3 decompression being key risk factors.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Minimally Invasive Procedures
Background:
- Microendoscopic laminectomy (MEL) is a minimally invasive spinal decompression technique.
- The procedure carries a risk of postoperative spinal epidural hematoma (POSEH).
- POSEH risk may increase with multiple-level MEL (m-MEL).
Purpose of the Study:
- To determine POSEH incidence rates for single-level (s-MEL) and m-MEL.
- To analyze POSEH incidence by interlaminar level.
- To identify risk factors for POSEH in m-MEL patients.
Main Methods:
- Retrospective analysis of 379 lumbar MEL patients (141 s-MEL, 238 m-MEL).
- Evaluation of POSEH incidence across interlaminar levels (L2/3, L3/4, L4/5).
- Correlation analysis of POSEH with operative findings, surgical sequence, and preoperative dural cross-sectional area (CSA) in m-MEL.
Main Results:
- POSEH incidence was significantly higher at L2/3 compared to L3/4 and L4/5.
- Operating on L2/3 as the final level correlated with increased L2/3 POSEH.
- Preoperative spinal stenosis and a CSA of 56 mm² were significant risk factors for L2/3 POSEH.
Conclusions:
- The L2/3 level exhibits the highest POSEH incidence in m-MEL.
- Performing L2/3 decompression last is a risk factor for POSEH.
- Spinal stenosis is a significant risk factor for POSEH at the L2/3 level during m-MEL.
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