gms | German Medical Science

Objective: Postoperative space occupying spinal epidural hematoma (SEH) is one complication in surgery for spinal degenerative diseases (SDD), requiring surgical revision. Here, we provide a systematic review of our institutional database of a 15 years interval (2002-2016), aiming to detect the incidence, the risk factors, and the functional outcome after SEH.

Methods: Retrospectively, we identified 6024 consecutive patients who had been treated surgically for SDD. 42 patients developed radiographically and symptomatic SEH and had to be revised surgically. We reviewed the charts, surgical reports and radiographic data for demographics, duration of symptoms, medications, co-morbidities, surgical strategy and neurological performance.

Results: The rate of SEH was 0.69 %. Operation sites were 1) cervical n=7 (16,7%), 2), thoracic n=1 (2.4%), and 3) lumbar n=34 (81%). Pain was the predominant symptom in 47.6 % (n =20), neurological deterioration was present in 21.4% (n=9), and 31% of the patients had both pain and functional deficits (n=13). Post revision surgery, complete recovery was found in n=23 patients (54.8%), incomplete recovery in n=15 patients (35.7%), and no recovery in n=5 (11.9%). Predictors for SEH were age > 50 years and the use of NSAR. Preoperative normal coagulation (p=0.033), pain as the only symptom (p=0.01), and revision surgery within 24 h (p=0.035) were significant predictors for complete recovery. Paraplegic (p=0.035) and obese (p=0.033) patients were at highest risk for poor neurological outcome.

Conclusion: In this large series, we identified age >50 years and the use of NSAR as significant risk factors for SEH. Early revision surgery, radiculopathy as only symptom, and normal blood clotting, were predictors for good neurological outcome in the SEH patients.