Assessment of Postoperative Epidural Hematoma after Lumbar Microendoscopic Surgery

Abstract

Introduction Symptomatic postoperative spinal epidural hematoma (SEH) is observed occasionally but rarely gets into serious complication after lumbar spinal surgery. It is also known that SEH occurs even in the endoscopic surgery. The purpose of this study is to assess characteristics and outcome of those cases which had SEH treated surgically after the initial microendoscopic surgery in the lumbar spine. Method From 2003 to 2015, total of 1249 patients with lumbar disc herniation or canal stenosis underwent microendoscopic discectomy or laminectomy in our institution. Traditional open spinal surgeries were compared with those microendoscopic surgeries. Six patients after microendoscopic surgery in the series required evacuation of SEH after the initial surgery were included in this study. Preoperative characteristics of the patients, clinical outcome and postoperative course were assessed. Result The incidence of SEH after microendoscopic surgeries required additional treatment was 0.48% (6 of 1249). The incidence of SHE after open spinal surgeries were 0.77% (11 of 1421). The initial procedure was microendscopic discectomy in three cases and microendoscopic laminotomy in three cases. One patient had hypertension, two patients had prediabetes and one patient had thrombocytopenia (12.110*3/μl) by hepatitis. Three cases were treated in the acute stage (within 24 hours after the surgery) and three cases were treated in the subacute stage (between 3 and 7 days after the surgery). In all cases, severe leg pain was appeared in short time. Two patients got muscle weakness. After the surgical evacuation of hematoma, all cases recovered from neurological symptoms and leg pain immediately. But one patient had repetitive leg pain after the evacuation with local anesthesia or general anesthesia. Finally Blood transfusion and factor VIII were required to stop SEH. Factor VIII activity of the patient was 58% at two days after the initial surgery. The patient fully recovered at six months after the initial surgery. Conclusion The incidence of SEH was not significant in comparison with a conventional method. It was considered that narrow epidural space by microendoscopic surgery affected dural compression by even a little bleeding. Basically, in preventing SEH, preoperative bleeding tendency, intraoperative bleeding, postoperative blood pressure and drainage should be confirmed. Even though, it was very difficult to detect the crucial factor of the symptomatic SHE, patient factor like bleeding and cerebrospinal pressure or iatrogenic factor like redundant invasion may lead to symptomatic SHE. Prompt treatment for symptomatic SEH was necessary.