Delayed postoperative spinal epidural hematomas.
Delayed postoperative spinal epidural hematomas.
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DOI：
10.1016/s1529-9430(02)00535-1
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发表时间：
2003-03-01
期刊：
影响因子：
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通讯作者：
Levi, Allan D O
中科院分区：
文献类型：
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作者：
Uribe, Juan;Moza, Kapil;Levi, Allan D O
背景情况：脊柱手术后的症状性硬膜外血肿并不常见，通常在手术后24小时内被诊断出来。目的：我们报告了一系列迟发性硬膜外血肿的患者，这些患者从手术中醒来，神经功能没有改变，然后在手术后3天以上恶化。本报告的目的是概述临床表现，放射学特征和结果，这种罕见的实体。研究设计/设置：我们回顾性审查了数据库的6名脊柱外科医生超过4年的时间，寻找存在硬膜外血肿作为一个原因，临床恶化后，无症状的术后至少3天。我们确定了一个患者子集，他们从手术中醒来，神经功能没有改变，然后在脊柱手术后3天以上恶化。在4年的回顾期内，共确定了4,018例患者。结局指标：存在脊髓硬膜外血肿作为临床恶化的原因后，至少3天的无症状期。的病历，包括历史，身体，术前和术后的神经系统检查，以及平片和磁共振images.METHODS：我们回顾性地审查了数据库的6个脊柱外科医生在4年的时间。我们寻找迟发性脊髓硬膜外血肿作为无症状术后至少3天后临床恶化的原因。我们研究了脊髓硬膜外血肿的潜在危险因素。结果：在4,018例患者中，我们确定了7例脊髓硬膜外血肿，他们在手术后3天以上出现。最初的症状，预示着随后发生的神经系统恶化，包括严重的剧痛与辐射到四肢。至神经功能恶化的平均时间为5.3天。57%的患者在硬膜外血肿部位有多次脊柱手术史。手术清除硬膜外血肿导致五名患者的神经功能改善。结论：迟发性脊髓硬膜外血肿是脊柱手术后迟发性恶化的罕见原因。既往手术伴随瘢痕形成导致血凝块吸收受损可能是病情发展的一个促成因素。
BACKGROUND CONTEXT: Symptomatic epidural hematomas after spinal surgery are uncommon and are usually diagnosed within 24 hours after surgery.PURPOSE: We report a series of delayed epidural hematomas in a subset of patients who awoke from surgery neurologically unchanged and then deteriorated more than 3 days after their index procedure. The goals of this report are to outline the clinical presentation, radiological characteristics and outcome of this uncommon entity.STUDY DESIGN/SETTING: We retrospectively reviewed the database of six spine surgeons over a 4-year period, looking for presence of epidural hematomas as a cause of clinical deterioration after an asymptomatic postoperative period of at least 3 days.PATIENT SAMPLE: We identified a subset of patients who awoke from surgery neurologically unchanged and then deteriorated more than 3 days after spinal surgery. A total of 4,018 patients were identified over the 4-year period of review.OUTCOME MEASURES: Presence of spinal epidural hematoma as a cause of clinical deterioration after an asymptomatic period of at least 3 days. The medical records, including the history, physical, preoperative and postoperative neurological examinations, as well as plain radiographs and magnetic resonance images, were reviewed.METHODS: We retrospectively reviewed the database of six spine surgeons over a 4-year period. We looked for delayed spinal epidural hematomas as a cause of clinical deterioration after an asymptomatic postoperative period of at least 3 days. We examined potential risk factors for spinal extradural hematomas.RESULTS: Of 4,018 patients, we identified seven with spinal epidural hematoma who presented more than 3 days after their index procedure. The initial presenting symptom, which heralded the subsequent onset of neurological deterioration, consisted of severe sharp pain with radiation to the extremities. The average time to neurological deterioration was 5.3 days. Fifty-seven percent of the patients had multiple previous spinal surgeries at the site of the epidural hematoma. Surgical evacuation of the epidural hematomas resulted in neurological improvement in five patients. Persistent neurological deficits were observed in two patients.CONCLUSION: Delayed spinal epidural hematomas are an uncommon cause of delayed deterioration after spinal surgery. Previous surgery with attendant scarring that results in impairment of clot resorption may be a contributing factor in the development of the condition.