Prospective study of postoperative lumbar epidural hematoma: Incidence and risk factors

Mark J. Sokolowski, Timothy A. Garvey, John Perl, Margaret S. Sokolowski, Woojin Cho, Amir A. Mehbod, Daryll C. Dykes, Ensor E. Transfeldt

Research output: Contribution to journalArticle

90 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)108-113
Number of pages6
JournalSpine
Volume33
Issue number1
DOIs
StatePublished - Jan 2008
Externally publishedYes

Fingerprint

Hematoma
Prospective Studies
Incidence
Decompression
International Normalized Ratio
Multivariate Analysis
Magnetic Resonance Imaging
Preoperative Care
Neurologic Manifestations
Ambulatory Surgical Procedures

Keywords

  • Hematoma volume
  • Incidence
  • Lumbar spine
  • Postoperative epidural hematoma
  • Risk factors

ASJC Scopus subject areas

  • Physiology
  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Sokolowski, M. J., Garvey, T. A., Perl, J., Sokolowski, M. S., Cho, W., Mehbod, A. A., ... Transfeldt, E. E. (2008). Prospective study of postoperative lumbar epidural hematoma: Incidence and risk factors. Spine, 33(1), 108-113. https://doi.org/10.1097/BRS.0b013e31815e39af

Prospective study of postoperative lumbar epidural hematoma : Incidence and risk factors. / Sokolowski, Mark J.; Garvey, Timothy A.; Perl, John; Sokolowski, Margaret S.; Cho, Woojin; Mehbod, Amir A.; Dykes, Daryll C.; Transfeldt, Ensor E.

In: Spine, Vol. 33, No. 1, 01.2008, p. 108-113.

Research output: Contribution to journalArticle

Sokolowski, MJ, Garvey, TA, Perl, J, Sokolowski, MS, Cho, W, Mehbod, AA, Dykes, DC & Transfeldt, EE 2008, 'Prospective study of postoperative lumbar epidural hematoma: Incidence and risk factors', Spine, vol. 33, no. 1, pp. 108-113. https://doi.org/10.1097/BRS.0b013e31815e39af
Sokolowski, Mark J. ; Garvey, Timothy A. ; Perl, John ; Sokolowski, Margaret S. ; Cho, Woojin ; Mehbod, Amir A. ; Dykes, Daryll C. ; Transfeldt, Ensor E. / Prospective study of postoperative lumbar epidural hematoma : Incidence and risk factors. In: Spine. 2008 ; Vol. 33, No. 1. pp. 108-113.
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abstract = "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.",
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T2 - Incidence and risk factors

AU - Sokolowski, Mark J.

AU - Garvey, Timothy A.

AU - Perl, John

AU - Sokolowski, Margaret S.

AU - Cho, Woojin

AU - Mehbod, Amir A.

AU - Dykes, Daryll C.

AU - Transfeldt, Ensor E.

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N2 - 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.

AB - 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.

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KW - Incidence

KW - Lumbar spine

KW - Postoperative epidural hematoma

KW - Risk factors

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