Postoperative lumbar spinal epidural hematoma: risk factors and clinical outcomes

English Keywords:Hematoma  Epidural  Lumbar spine  Risk factor

English Abstract:

  【Abstract】 Objectives: To investigate the risk factors of postoperative lumbar spinal epidural hematoma and the neurological outcomes. Methods: From January 2009 to January 2014, 1225 cases with lumbar disc herniation(LDH) or lumbar spinal stenosis(LSS) underwent decompression and instrumentation in our department. 8 of them were complicated with epidural hematoma which caused neurologic deterioration. All these patients were followed up. 24 patients with the same diagnosis and undergoing the same operation by the same surgeon were selected as control. The age, gender, hypertension history, diabetes mellitus(DM) history, non-steroidal anti-inflammatory drugs(NSAIDs) taken history, use of anticoagulation, revision surgery or not, number of fusion segments, operation time, blood loss, frozen plasma transfusion of two groups were recorded. The data were analyzed by using multiple Logistic regression model to determine the significance of the individual factor and the odds ratios(OR). Results: Through multiple Logistic regression, it was found that age of more than 65 years old and revision surgery were the preoperative risk factors, while operation time of more than 120 minutes, blood loss of more than 600ml, frozen plasma transfusion were the intra-operative risk factors. After the debridement of hematoma, the clinical outcome showed complete recovery in 2 cases, incomplete recovery in 4 cases, no change in 2 cases. Conclusions: Patients with age of more than 65 years old, revision surgery, operation time of more than 120 minutes, blood loss of more than 600ml, frozen plasma transfusion may be the risk factors of postoperative lumbar spinal epidural hematoma. After the debridement of hematoma, the neurological function improves in most of the patients but the results was unsatisfactory.