Incidence and risk factors of symptomatic epidural hematoma in posterior cervical surgery

English Keywords:Epidural hematoma  Posterior spine surgery  Risk factors

English Abstract:

  【Abstract】 Objectives: To explore the incidence and risk factors of symptomatic epidural hematoma(SEH) in posterior cervical surgery, and to provide evidence and intervention for clinical prevention. Methods: Retrospective review of patients who received posterior cervical laminoplasty or laminectomy was made from September 2012 to September 2017(exclude patients with fractures, dislocation, infections or tumors), and all the patients with SEH were identified as SEH group. The control group was randomly chosen from patients without hematoma, with quantity four times of SEH group. Factors which might affect SEH occurrence were collected: gender, age, body mass index, ossification of posterior ligament(OPLL), trauma, hypertension, diabetes, vascular atherosclerotic diseases, anti-platelet drugs, platelet count, prothrombin time, activated partial thromboplastin time, international normalized ratio, serum total protein, serum albumin, blood calcium, segments, instrumental fixation, laminectomy, duration of surgery and estimated blood loss. t-test, Chi-square test and multifactor logistic regression analysis were used to investigate the correlation of factors and SEH. Results: A total of 3859 patients received posterior cervical surgery, among whom 19 cases suffered from SEH with the incidence of 0.49%. The median time of SEH occurrence was 120min(range, 30min to 15d). 2 cases firstly presented with numbness, other 17 cases firstly presented with paralysis, and all cases suffered from paralysis before hematoma evacuation. Frankel grade was B in 4 cases, C in 13 cases and D in 2 cases. 7 cases were radiologically diagnosed by MRI, the other 12 cases were diagnosed by clinical manifestation. All 19 patients received emergent hematoma evacuation and recovered at least one grade after evacuation. There were significant differences of OPLL, surgical segments, instrumental length, duration and estimated blood loss between the two groups in univariable test(P<0.05). Multifactor logistic regression showed that surgical segments and OPLL were the risk factors of postoperative SEH(P<0.05). Conclusions: Segments and OPLL are the risk factors of postoperative SEH. For patients with these risk factors, neurological functions should be under restrict surveillance, and drains obstruction should be prevented.