Incidence of postoperative symptomatic epidural hematoma in spinal decompression surgery Clinical article
Incidence of postoperative symptomatic epidural hematoma in spinal decompression surgery Clinical article
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DOI：
10.3171/2011.3.spine10716
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发表时间：
2011-08-01
影响因子：
2.8
通讯作者：
Iwasaki, Motoki
中科院分区：
文献类型：
--
作者：
Aono, Hiroyuki;Ohwada, Tetsuo;Iwasaki, Motoki
目的。脊髓硬膜外血肿（SEH）导致的神经功能恶化是脊柱手术的一种罕见但重要的并发症。据报道，脊柱手术后血肿清除的频率为0.1%-3%。本研究的目的是调查 SEH 的症状和脊柱减压手术后每次手术的疏散频率。方法。这是一项对 1986 年至 2005 年间接受脊柱减压手术后接受 SEH 清除的 26 名患者的回顾性研究。在此期间，共进行了 6356 例脊柱减压手术。研究的因素包括每次手术的 SEH 清除频率、症状、SEH 清除时间、合并症和神经功能恢复。结果。所有操作中 SEH 疏散的频率为 0.41%（6356 次中的 26 次）。标准腰椎间盘切除术中每种手术的频率为 0%（1568 例中的 0 例），腰椎椎板切除术中为 0.50%（1614 例中的 8 例），后腰椎椎间融合术中为 0.67%（1191 例中的 8 例），胸椎椎板切除术中为 4.46%（112 例中的 5 例），颈椎椎板切除术中为 0.44%（910 例中的 4 例）椎板成形术，以及颈椎前路脊柱融合术中的 0.21%（466 例中的 1 例）。九名患者患有涉及出血的合并症。初次手术后 4 小时至 8 天进行脊髓硬膜外血肿清除术。大多数接受颈椎和/或胸部手术的患者在 24 小时内观察到严重瘫痪，而接受腰椎手术的患者中有一半在抽吸引流管拔除后出现腿部疼痛或膀胱功能障碍等 SEH 症状。撤离时间越短，神经功能恢复效果越好。结论。术后 SEH 在胸椎板切除术后最为常见。在颈胸手术中，SEH症状在24小时内出现，多为严重瘫痪，腰椎手术患者中近一半在抽吸引流拔除后出现症状。 （DOI：10.3171/2011.3.SPINE10716）
Object. Neurological deterioration due to spinal epidural hematoma (SEH) is a rare but significant complication of spinal surgery. The frequency of hematoma evacuation after spinal surgery is reportedly 0.1%-3%. The objective of this study was to investigate the symptomatology of SEH and the frequency of evacuation for each surgical procedure after spinal decompression surgery.Methods. This is a retrospective study of 26 patients who underwent SEH evacuation after spinal decompression surgery between 1986 and 2005. During this period, 6356 spinal decompression surgeries were performed. The factors studied were the frequency of SEH evacuation for each surgical procedure, symptoms, time to SEH evacuation, comorbidities, and neurological recovery.Results. The frequency of SEH evacuation was 0.41% (26 of 6356) for all operations. The frequency for each surgical procedure was 0% (0 of 1568) in standard lumbar discectomy, 0.50% (8 of 1614) in lumbar laminectomy, 0.67% (8 of 1191) in posterior lumbar interbody fusion, 4.46% (5 of 112) in thoracic laminectomy, 0.44% (4 of 910) in cervical laminoplasty, and 0.21% (1 of 466) in cervical anterior spinal fusion. Nine patients had comorbidities involving hemorrhage. Spinal epidural hematoma evacuation was performed between 4 hours and 8 days after the initial operation. Whereas severe paralysis was observed within 24 hours in most patients undergoing cervical and/or thoracic surgery, half of the patients undergoing lumbar surgery had symptoms of SEH such as leg pain or bladder dysfunction after suction drain removal. The shorter the period to evacuation, the better were the results of neurological recovery.Conclusions. Postoperative SEH was most frequent after thoracic laminectomy. In cervical and thoracic surgeries, symptoms of SEH were noted within 24 hours, mostly severe paralysis, and almost half of the lumbar surgery patients had symptoms after suction drain removal. (DOI: 10.3171/2011.3.SPINE10716)