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Postoperative hematomas after successful lumbar microdiscectomy or percutaneous nucleotomy: a magnetic resonance
E Kotilainen1, A Alanen, M Erkintalo
1Department of Neurosurgery, University of Turku, Finland.
Abstract:
We evaluated the incidence of postoperative extradural hematomas by means of magnetic resonance imaging (MRI) technique in 44 patients who underwent successful surgery for a virgin lumbar disc herniation. Of these patients, 28 were treated with microdiscectomy and 16 with percutaneous nucleotomy. Postoperative hematoma proved to be a universal MRI finding in the microsurgically treated patients: hematomas were found in all patients in the microdiscectomy group. In 12 (43%) patients the hematoma extended into the dural sack. The incidence of hematomas was significantly (p = 0.001) lower in the patients treated with percutaneous nucleotomy: hematomas were detected in only 10 (63%) of the 16 patients in the nucleotomy group. The hematomas in these patients were also smaller in size and none of them connected with the dural sac. Correlation between the hematomas and clinical findings showed that the presence of a hematoma had no obvious effect on the immediate postoperative recovery of a patient.
Insights
Magnetic resonance imaging (MRI) revealed postoperative extradural hematomas are common after lumbar disc herniation surgery. Percutaneous nucleotomy resulted in significantly fewer and smaller hematomas compared to microdiscectomy, with no clinical impact.
Area of Science:
- Neurosurgery
- Radiology
- Spinal Surgery
Background:
- Postoperative extradural hematomas can occur following lumbar disc herniation surgery.
- The incidence and characteristics of these hematomas have not been fully elucidated using advanced imaging techniques.
Purpose of the Study:
- To evaluate the incidence and characteristics of postoperative extradural hematomas using magnetic resonance imaging (MRI).
- To compare hematoma formation between microdiscectomy and percutaneous nucleotomy for virgin lumbar disc herniation.
Main Methods:
- Retrospective analysis of 44 patients undergoing surgery for virgin lumbar disc herniation.
- Magnetic resonance imaging (MRI) was used to detect and characterize postoperative extradural hematomas.
- Patients were divided into two groups: microdiscectomy (n=28) and percutaneous nucleotomy (n=16).
Main Results:
- Postoperative extradural hematomas were detected in all patients (100%) treated with microdiscectomy.
- Hematomas extended into the dural sac in 43% of microdiscectomy patients.
- Hematomas were found in 63% of percutaneous nucleotomy patients, with significantly lower incidence (p=0.001), smaller size, and no dural sac extension.
Conclusions:
- Extradural hematoma formation is a frequent MRI finding after microdiscectomy for lumbar disc herniation.
- Percutaneous nucleotomy demonstrates a lower incidence of extradural hematomas compared to microdiscectomy.
- The presence of postoperative hematomas did not appear to affect immediate clinical recovery in this cohort.