Abstract
Background Symptomatic postoperative spinal epidural hematoma (PSEH) is a devastating complication that could develop after lumbar decompression surgery. PSEH can also develop after biportal endoscopic spine surgery (BESS), one of the recently introduced minimally invasive spine surgery techniques. Gelatin-thrombin matrix sealant (GTMS) is commonly used to prevent PSEH. This study aimed at analyzing the clinical and radiological effects of GTMS use during BESS. Methods A total of 206 patients with spinal stenosis who underwent decompression by BESS through a posterior interlaminar approach from October 2015 to September 2018 were enrolled in this study. Postoperative magnetic resonance imaging (MRI) was performed in all patients for evaluation of PSEH. Patients in whom GTMS was not used during surgery were assigned to Group A, and those in whom GTMS was used were classified as Group B. In the clinical evaluation, the visual analog scale (VAS) of the leg and back, Oswestry Disability Index (ODI), and modified MacNab criteria were used. The incidence rate and degree of dural compression of PSEH on postoperative MRI were measured. Results The average age of the patients was 68.1 ± 11.2 (42–89) years. The overall incidence rate of PSEH was 20.9% (43/206). The incidence rates in Groups A and B were 26.4% and 13.6%, respectively, showing a significant difference (p = 0.023). The VAS-leg and ODI improvement was significantly different depending on the intraoperative use of GTMS. However, there was no statistically significant difference between the two groups in terms of the VAS-back improvement. Groups A and B showed “good” and “excellent” rates according to the modified MacNab criteria in 79.4% and 87.6% of patients, respectively, showing statistically significant difference (p = 0.049). In Group A, two patients underwent revision surgery due to PSEH, while none in Group B had such event. Conclusion Intraoperative use of GTMS during BESS may be related to reduction in the occurrence rate of PSEH. Specifically, patients with GTMS appliance showed marked decrease in the occurrence of PSEH and had better clinical outcomes.
Highlights
Postoperative spinal epidural hematoma (PSEH) is one of the most common early complications of spine surgery that can cause neurological symptoms [1, 2]
A gelatin-thrombin matrix sealant (GTMS) is a wellknown biocompatible hemostatic matrix composed of bovine gelatin matrix and human-derived thrombin used during spine surgery [6]
Two patients with Grade III postoperative spinal epidural hematoma (PSEH) had postoperative neurologic symptoms, including radiating pain on both lower extremities that were intractable to conservative treatment and underwent revision surgery of PSEH evacuation
Summary
Postoperative spinal epidural hematoma (PSEH) is one of the most common early complications of spine surgery that can cause neurological symptoms [1, 2]. A gelatin-thrombin matrix sealant (GTMS) is a wellknown biocompatible hemostatic matrix composed of bovine gelatin matrix and human-derived thrombin used during spine surgery [6]. Such GTMSs are known to promote fibrin formation and coagulation [7]. Symptomatic postoperative spinal epidural hematoma (PSEH) is a devastating complication that could develop after lumbar decompression surgery. Groups A and B showed “good” and “excellent” rates according to the modified MacNab criteria in 79.4% and 87.6% of patients, respectively, showing statistically significant difference (p = 0:049). Patients with GTMS appliance showed marked decrease in the occurrence of PSEH and had better clinical outcomes
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