The management of symptomatic epidural hematoma after the posterior lumbar surgery

English Abstract:

  【Abstract】 Objectives: A retrospective study was made to analyze the causes and management of symptomatic epidural hematoma after the posterior lumbar surgery. Methods: From January 2008 to December 2014, 21 of 12827 cases got symptomatic epidural hematoma after the posterior lumbar surgery, 2 cases with lumbar disc herniation, 17 cases with lumbar spinal stenosis, and 2 cases with lumbar spondylolisthesis (grade Ⅰ). 13 males and 8 females with a mean age of 53.0±11.6 years old(range, 34 to 78 years) were included in this study. Operation segments included 1 segment in 8 cases, 2 segments in 9 cases, and more than 3 segments in 4 cases. All patients were operated successfully, the anesthesia time was 219±66 min(range, 141-383min), the operation time was 147±51min(range, 96-312min), and the bleeding volume was 485±410ml (range, 50-2000ml). After operation, 1 drainage tube was placed. Postoperative neurological symptoms of 21 patients occurred after anesthesia awake from 1h to 5d, neural function was assessed according to the ASIA neurological function grade: A in 7 cases, B in 3 cases, C in 8 cases, and D in 3 cases. All of them underwent lumber canal exploration and hematoma debridement. The causes of complications and corresponding interventions were documented. The recovery of ASIA grade was ewcorded. Results: In all of 21 patients who had undergone lumber canal exploration and hematoma debridement, the intraspinal venous plexus were still bleeding in 4 cases, the dural sac and nerve root were compressed by the blood clot under collagen sponge hemostatics in 2 cases, and drainage tubes were folded in the wound in 2 cases. However, hematoma pressure of 11 cases was higher than normal, but no bleeding was found. 2 cases obsolete blood clots and dark color had no bleeding, dural sac or nerve root edematous. 9 cases(A in 2 cases, B in 1 case, C in 4 cases, D in 2 cases) were performed reoperation within the first 6 hours. The neural function was assessed E in 1 case and D in 8 cases. 7 cases(A in 2 cases, B in 1 case, C in 3 cases, D in 1 case) were performed reoperation within 6-24 hours and the neural function was improved to B in 1 case, C in 2 cases, D in 3 cases, E in 1 case. But 5 cases(A in 3 cases, B in 1 case, C in 1 case) were performed reoperation after 24 hours of surgery recovered dissatisfiedly, their neural function was assessed A in 1 case, B in 2 cases, C in 2 cases. All of 21 patients were followed up by an average of 2.0±0.8 years(range, 11 months-4 years). At the final follow-up, all of them were satisfied with recovery of neural function: E in 16 cases, D in 4 cases. 1 case had neurological symptoms 5 days after surgery discharged from hospital, and 12 days later, he was admitted to hospital again. ASIA grade was A, no improvement was found after the exploration, and after 11 month recovery therapy, it improved to grade C. Conclusions: After lumbar epidural hematoma is debrided, most of cases gain improvement. The earlier to explore and debride hematoma the better to neural functional recovery. So careful hemostasis, effective drainage, and timely management are key measures to prevent and treatment epidural hematoma.