Symptomatic postoperative spinal epidural hematoma after spine tumor surgery: Incidence, clinical features, and risk factors

Abstract

Study design

Case-control study.

Objectives

The objective of this study was to provide some useful information concerning the incidence, clinical features, and risk factors for symptomatic postoperative spinal epidural hematoma (SPSEH) in an isolated cohort of patients undergoing spine tumor surgery.

Setting

Hospital in Shanghai, China.

Methods

We retrospectively reviewed all patients who underwent surgery for spine tumors between August 2012 and August 2017, and conducted a case-control study involving 16 patients who received evacuation surgery due to SPSEH after spine tumor surgery and 48 controls without SPSEH. Case and control subjects were matched at 1:3 by pathological diagnosis, tumor size (±1 cm), resection mode, surgical approach, and the operation team. Data of SPSEH subjects along with 48 matched controls were further obtained from a detailed review of the medical records. Univariate and multivariate analyses were conducted to identify the risk factors for developing SPSEH.

Results

SPSEH evacuation surgery was performed after 16 of 5421 (0.30%) spine tumor surgeries. Angiogenic tumors were the most susceptible tumors developing SPSEH. Very large hematomas, continuous blood loss, and delayed hematomas were characteristic clinical presentations for SPSEH after spine tumor surgery. Multiple logistic regression analysis suggested that patients suffering from at least one medical comorbidity and patients with Frankel grade of A-C had a significantly higher risk of developing SPSEH.

Conclusions

The incidence of SPSEH after spine tumor surgery requiring surgical evacuation was 0.30%. Medical comorbidity and Frankel grade were identified as independent risk factors for SPSEH development.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

References

  1. 1.

    Sokolowski MJ, Garvey TA, Perl J 2nd, Sokolowski MS, Cho W, Mehbod AA, et al. Prospective study of postoperative lumbar epidural hematoma: incidence and risk factors. Spine . 2008;33:108–13.

  2. 2.

    Ikuta K, Tono O, Tanaka T, Arima J, Nakano S, Sasaki K, et al. Evaluation of postoperative spinal epidural hematoma after microendoscopic posterior decompression for lumbar spinal stenosis: a clinical and magnetic resonance imaging study. J Neurosurg Spine. 2006;5:404–9.

  3. 3.

    Yamada K, Abe Y, Satoh S, Yanagibashi Y, Hyakumachi T, Masuda T. Large Increase in Blood Pressure After Extubation and High Body Mass Index Elevate the Risk of Spinal Epidural Hematoma After Spinal Surgery. Spine . 2015;40:1046–52.

  4. 4.

    Amiri AR, Fouyas IP, Cro S, Casey AT. Postoperative spinal epidural hematoma (SEH): incidence, risk factors, onset, and management. Spine J. 2013;13:134–40.

  5. 5.

    Aono H, Ohwada T, Hosono N, Tobimatsu H, Ariga K, Fuji T, et al. Incidence of postoperative symptomatic epidural hematoma in spinal decompression surgery. J Neurosurg Spine. 2011;15:202–5.

  6. 6.

    Awad JN, Kebaish KM, Donigan J, Cohen DB, Kostuik JP. Analysis of the risk factors for the development of post-operative spinal epidural haematoma. J Bone Jt Surg Br. 2005;87:1248–52.

  7. 7.

    Glotzbecker MP, Bono CM, Wood KB, Harris MB. Postoperative spinal epidural hematoma: a systematic review. Spine. 2010;35:E413–20.

  8. 8.

    Kou J, Fischgrund J, Biddinger A, Herkowitz H. Risk factors for spinal epidural hematoma after spinal surgery. Spine. 2002;27:1670–3.

  9. 9.

    Giugno A, Basile L, Maugeri R, Iacopino DG. Emergency surgery in a patient with large spontaneous spinal epidural hematoma determining excellent neurological recovery: review of the literature. Spinal Cord. 2014;52(Suppl 3):S22–4.

  10. 10.

    Fujiwara Y, Manabe H, Izumi B, Harada T, Nakanishi K, Tanaka N, et al. The impact of hypertension on the occurrence of postoperative spinal epidural hematoma following single level microscopic posterior lumbar decompression surgery in a single institute. Eur Spine J. 2017;26:2606–15.

  11. 11.

    Goldstein CL, Bains I, Hurlbert RJ. Symptomatic spinal epidural hematoma after posterior cervical surgery: incidence and risk factors. Spine J. 2015;15:1179–87.

  12. 12.

    Kao FC, Tsai TT, Chen LH, Lai PL, Fu TS, Niu CC, et al. Symptomatic epidural hematoma after lumbar decompression surgery. Eur Spine J. 2015;24:348–57.

  13. 13.

    Domenicucci M, Mancarella C, Santoro G, Dugoni DE, Ramieri A, Arezzo MF, et al. Spinal epidural hematomas: personal experience and literature review of more than 1000 cases. J Neurosurg Spine. 2017;27:198–208.

  14. 14.

    Lillemae K, Jarvio J, Silvasti-Lundell MK, Antinheimo J, Hernesniemi J, Niemi TT. Incidence of postoperative hematomas requiring surgical treatment in neurosurgery: a retrospective observational study. World Neurosurg. 2017;108:491–7.

  15. 15.

    Boriani S, Gasbarrini A, Bandiera S, Ghermandi R, Lador R. Predictors for surgical complications of en bloc resections in the spine: review of 220 cases treated by the same team. Eur Spine J. 2016;25:3932–41.

  16. 16.

    Luzzati AD, Shah S, Gagliano F, Perrucchini G, Scotto G, Alloisio M. Multilevel en bloc spondylectomy for tumors of the thoracic and lumbar spine is challenging but rewarding. Clin Orthop Relat Res. 2015;473:858–67.

  17. 17.

    Yang W, Jiang L, Liu X, Wei F, Yu M, Wu F, et al. Surgical complications of extraspinal tumors in the cervical spine: a report of 110 cases and literature review. Eur Spine J. 2018;27:882–90.

  18. 18.

    Shin HK, Choi I, Roh SW, Rhim SC, Jeon SR. Relevance of postoperative magnetic resonance images in evaluating epidural hematoma after thoracic fixation surgery. World Neurosurg. 2017;107:803–8.

  19. 19.

    Lawton MT, Porter RW, Heiserman JE, Jacobowitz R, Sonntag VK, Dickman CA. Surgical management of spinal epidural hematoma: relationship between surgical timing and neurological outcome. J Neurosurg. 1995;83:1–7.

  20. 20.

    Uribe J, Moza K, Jimenez O, Green B, Levi AD. Delayed postoperative spinal epidural hematomas. Spine J. 2003;3:125–9.

  21. 21.

    Groen RJ, Ponssen H. The spontaneous spinal epidural hematoma. A study of the etiology. J Neurol Sci. 1990;98:121–38.

  22. 22.

    Anderson FA Jr., Spencer FA. Risk factors for venous thromboembolism. Circulation . 2003;107(23Suppl 1):I9–16.

  23. 23.

    Laglia AG, Eisenberg RL, Weinstein PR, Mani RL. Spinal epidural hematoma after lumbar puncture in liver disease. Ann Intern Med. 1978;88:515–6.

  24. 24.

    Shahlaie K, Fox A, Butani L, Boggan JE. Spontaneous epidural hemorrhage in chronic renal failure. A case report and review. Pedia Nephrol. 2004;19:1168–72.

  25. 25.

    Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.

Download references

Author information

Conception and design: T Liu, Xiao, Gao; Acquisition of data: Gao, Li, Cao; Analysis and interpretation of data: Gao, Li, Cao; Drafting the article: Gao.; Statistical analysis: Zhao, Y Liu; Reviewed submitted version of manuscript: Yang; Administrative/technical/material support: Dong; Revising the article: Wan; Study supervision: Xiao, T Liu, Wan.

Correspondence to Wei Wan or Tielong Liu or Jianru Xiao.

Ethics declarations

Ethics

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark