Intracranial hemorrhage following spinal interventions: A comparison between major surgical procedures versus...

This study systematically reviews the incidence, types, and management of intracranial hemorrhage (ICH) following major and minor spinal procedures, highlighting demographic trends, risk factors, and treatment outcomes to standardize clinical practices and improve patient safety. ICH following spine procedures, both major and minimally invasive, remains a rare but severe complication. The exact etiological factors are yet to be fully identified, though cerebrospinal fluid (CSF) leakage and decreased intracranial pressure are significant contributors. A comprehensive literature search identified 114 studies reporting ICH cases from minor post-spinal procedures. A total of 138 patients were included. Data were extracted on demographics, types of spinal procedures, ICH, and management strategies. A database from a previously published paper, which included 109 patients postmajor spinal procedures, was incorporated for comparative analysis to identify patterns and differences. Our study analyzed 138 cases of ICH following minimally invasive spinal procedures, compared to 109 postmajor cases. Females predominated in the minimally invasive group (88.7%). Subdural hematoma was significantly higher in minor procedures (90%), while cerebellar hemorrhage occurred only in major procedures (56.9%). Needle sizes varied, with 18 Gauge needles used in 17% of cases and 66.1% reported as "Others." Mortality rates were comparable between major (3.7%) and minor (5.7%) procedures, indicating similar risk levels. ICH following spinal procedures, particularly minor ones, presents a significant clinical challenge. The findings underscore the need for customized treatment strategies and vigilant monitoring, especially in younger, healthier populations. Study limitations include potential publication bias and heterogeneity, highlighting the need for further research with more extensive, diverse samples to validate these findings.