Symptomatic postoperative spinal epidural hematoma preferentially occurs after anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion: a retrospective study.

Abstract

Cervical spondylotic myelopathy (CSM) is a common cause of neurological morbidity, which can have an impact on quality of life. Symptomatic postoperative spinal epidural hematoma (SPSEH) is a rare condition, but can cause permanent neurological deficits and disability if not managed properly. However, there are limited studies on the outcomes of SPSEH after anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) were performed for 2-level CSM. Therefore, the aim of the present study was to compare the clinical outcomes and incidence of SPSEH after ACDF compared with SPSEH after anterior cervical corpectomy and ACCF for 2-level CSM to reduce surgical complications of 2 level CSM. A total of 551 patients (261 males and 290 females) who underwent ACDF or ACCF for 2-level CSM from January 2009 to February 2015 were retrospectively reviewed. Preoperative indexes (age, sex, body mass index, bone mineral density, preoperative coagulation, and past medical history), perioperative indexes (length of hospital admission, blood loss, and operation times), preoperative and postoperative neurological statuses, complications, fusion rate, and the SPSEH incidence for ACDF or ACCF were compared simultaneously. With the exception of blood loss (P<0.001), no significant differences were observed between the 2 groups in terms of sex, prothrombin time, activated partial thromboplastin time, platelet count, length of hospital admission, operation time, the final follow-up Japanese Orthopedic Association score, visual analog scale score, fusion rate, and complications. The overall incidence rate for SPSEH after ACDF was 1.9%, while the rate for SPSEH after ACCF was 0.4%. Following hematoma removal, only one patient showed any improvement in neurological function, despite treatment with hyperbaric oxygen and neurotrophic drugs. The findings indicated that surgical management of 2-level CSM using ACDF or ACCF showed similar clinical outcomes, fusion rate, complications, and perioperative parameters, with the exception of blood loss. However, SPSEH preferentially occurs after surgery with ACDF. Therefore, whether ACCF surgery for 2-stage CSM is the superior treatment modality.