Document Detail


Prospective study of postoperative lumbar epidural hematoma: incidence and risk factors.
MedLine Citation:
PMID:  18165756     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY DESIGN: Prospective clinical series. OBJECTIVE: To determine the incidence, volume, and extent of postoperative epidural hematoma resulting in thecal sac compression, and to identify risk factors correlated with measured hematoma volumes. SUMMARY OF BACKGROUND DATA: Risk factors for postoperative hematoma development have been retrospectively determined in small populations of symptomatic patients. A prospective study of hematoma characteristics and associated risk factors in a consecutive series of patients could significantly enhance our understanding of postoperative hematoma. METHODS: Preoperative magnetic resonance imaging and clinical data on 13 pre- and intraoperative risk factors were prospectively collected on 50 consecutive patients undergoing lumbar decompression surgery with or without fusion. Postoperative magnetic resonance imagings were performed within 2 to 5 days of surgery. Thecal sac cross-sectional area was calculated at each disc space. Relative thecal sac compression due to hematoma was calculated at all levels where postoperative cross-sectional area was smaller than preoperative. Hematoma volumes were calculated. Multivariate analysis identified risk factors associated with postoperative hematoma volume. RESULTS: After decompression, 58% of patients developed epidural hematoma of sufficient magnitude to compress the thecal sac beyond its preoperative state at one or more levels. None developed new postoperative neurologic deficits. A mean of 1.4 levels were decompressed. Hematoma extended over a mean of 1.9 levels. Maximal thecal sac compression due to hematoma occurred at an adjacent, nondecompressed level in 28% of patients. Multivariate analysis found age greater than 60, multilevel procedures, and preoperative international normalized ratio to be associated with larger hematoma volumes. CONCLUSION: Lumbar decompression surgery results in a 58% incidence of asymptomatic compressive postoperative epidural hematoma. Adjacent level compression by hematoma occurs in 28% of patients. Advanced age, multilevel procedures, and international normalized ratio are independently associated with postoperative hematoma volume.
Authors:
Mark J Sokolowski; Timothy A Garvey; John Perl; Margaret S Sokolowski; Woojin Cho; Amir A Mehbod; Daryll C Dykes; Ensor E Transfeldt
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Spine     Volume:  33     ISSN:  1528-1159     ISO Abbreviation:  Spine     Publication Date:  2008 Jan 
Date Detail:
Created Date:  2007-12-31     Completed Date:  2008-01-17     Revised Date:  2009-07-09    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  108-13     Citation Subset:  IM    
Affiliation:
Twin Cities Spine Center, Minneapolis, MN, USA. mjsokolowski@yahoo.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Female
Hematoma, Epidural, Spinal* / epidemiology,  etiology,  pathology
Humans
Lumbar Vertebrae / surgery*
Magnetic Resonance Imaging
Male
Middle Aged
Minnesota / epidemiology
Orthopedic Procedures / adverse effects*
Postoperative Complications*
Prospective Studies
Risk Factors
Spinal Cord Diseases* / epidemiology,  etiology,  pathology
Spine / pathology,  surgery*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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