Incidence of Symptomatic Postoperative Spinal Epidural Hematoma in 5,941 Cases and Functional Outcomes Following Hematoma Evacuation

Saturday, May 4, 2024

3:59 PM – 4:01 PM CT

Presenting Author(s)

Ziam Khan, BS

Medical Student
University of Maryland, School of Medicine
Baltimore, MD, US

Co-Author(s)

CA

Carlos Aguilera, BS

Medical Student
Georgetown University School of Medicine, United States
JB

Jean-Paul Bryant, MD, MPH, MS

Resident Physician
Medstar Georgetown University Hospital, United States
DF

Daniel Felbaum, MD

Neuroendvoascular Neurosurgeon
Medstar Washington Hospital Center
Washington, District of Columbia, United States
AK

Alexander Kim, BA

Medical Student
Georgetown University School of Medicine, United States
MN

Mani Nair, MD, MPH, MBA

Associate Professor of Neurosurgery
Medstar Georgetown University Hospital, United States

Co-Author(s)

Gnel Pivazyan, MD (he/him/his)

Resident Physician
Medstar Georgetown University Hospital
Washington, District of Columbia, United States

Co-Author(s)

FS

Faheem Sandhu, MD, PhD

Professor of Neurosurgery
Medstar Georgetown University Hospital, United States
JV

Jean-Marc Voaydzis, MD

Associate Professor of Neurosurgery
Medstar Georgetown University Hospital, United States

Disclosure(s):

Ziam Khan, BS: No financial relationships to disclose

Gnel Pivazyan, MD: Stryker/K2M: Research Grant (Terminated, July 1, 2022)

Introduction: Symptomatic postoperative spinal epidural hematomas (PEDHs) are rare complications with significant implications on functional outcomes and quality of life of the patients. This study sought to evaluate the incidence of PEDH according to the spinal region and approach as well as the functional outcomes of patients suffering from symptomatic PEDH.

Methods: This is a single institution study of all PEDH cases requiring a reoperation between June 2017 to July 2023. All patients undergoing posterior spinal surgeries and anterior cervical discectomy and fusion (ACDF) were included. Intradural pathologies and exclusively anterolateral thoracolumbar approaches were excluded. The incidence of PEDH was calculated by region and operative technique.

Results: A total of 5,941 spinal operations and 40 symptomatic PEDH cases requiring reoperation were identified (0.67% incidence). Mean Charleston Comorbidity Index was 3.7 ± 2.09, and number of levels operated 2.53 ± 1.62. PEDH incidence according to region was as follows ACDF: 0.44%, posterior cervical: 0.68%, posterior thoracic: 0.70%, MIS and open lumbar decompressions: 1.17% and 0.44%, respectively, MIS and open lumbar decompressions with fusions 0.33% and 0.70%, respectively. Compared to open, MIS lumbar decompressions had more twice the incidence of PEDH (p = 0.10). Of the 35 patients undergoing posterior approach, the PEDH presentation involved motor weakness in 17 (48.57%) of the cases, 9 cervicothoracic and 8 lumbar. 10 (28.57% of total PEDH cases) of those patients had complete resolution of motor weakness while 7 had some improvement. Among the 10 cases with weakness resolution, the mean resolution time was 4.60 ±3.63 days. The 18 cases without motor weakness on presentation included 1 cervicothoracic and 17 lumbar cases.

Conclusion : While the incidence of PEDH falls below one percent, nearly half of these developed motor weakness as a presenting symptom and the third of the patients never had resolution of the weakness.