Perspective: Postoperative spinal epidural hematomas (pSEH) should be treated, not ignored

Area of Science:

• Neurosurgery
• Spinal Surgery
• Neurology

Background:

• Postoperative spinal epidural hematomas (pSEH) are a serious complication of spinal surgery, potentially leading to paralysis.
• Prompt diagnosis and emergency treatment are essential for patients with pSEH to avoid permanent neurological deficits.

Purpose of the Study:

• To highlight the critical need for immediate recognition and management of pSEH.
• To emphasize the role of MR imaging and emergent surgical decompression in preventing paralysis.

Main Methods:

• Review of literature on the incidence, predisposing factors, and timing of pSEH development.
• Analysis of diagnostic and therapeutic strategies for pSEH.

Main Results:

• Symptomatic pSEH can occur within hours to days after spinal surgery, with reported frequencies ranging from 0.1% to 4.46%.
• Predisposing factors include coagulation disorders, multilevel or previous spine surgeries, and intraoperative cerebrospinal fluid (CSF) leaks.
• Cervical and thoracic pSEH tend to become symptomatic faster than lumbar pSEH.

Conclusions:

• Early identification of neurological deficits following spinal surgery necessitates immediate MR studies to diagnose pSEH.
• Emergent surgical decompression, with or without fusion, is critical for limiting or averting permanent neurological sequelae.
• All patients undergoing spinal procedures with suspected pSEH require prompt postoperative MR imaging and timely intervention.