Analysis of the risk factors for the development of post-operative spinal epidural haematoma.
ABSTRACT In order to identify the risk factors and the incidence of post-operative spinal epidural haematoma, we analysed the records of 14 932 patients undergoing spinal surgery between 1984 and 2002. Of these, 32 (0.2%) required re-operation within one week of the initial procedure and had an International Classification of Diseases (ICD)-9 code for haematoma complicating a procedure (998.12). As controls, we selected those who had undergone a procedure of equal complexity by the same surgeon but who had not developed this complication. Risks identified before operation were older than 60 years of age, the use of pre-operative non-steroidal anti-inflammatories and Rh-positive blood type. Those during the procedure were involvement of more than five operative levels, a haemoglobin < 10 g/dL, and blood loss > 1 L, and after operation an international normalised ratio > 2.0 within the first 48 hours. All these were identified as significant (p < 0.03). Well-controlled anticoagulation and the use of drains were not associated with an increased risk of post-operative spinal epidural haematoma.
- SourceAvailable from: Ahmet Tolgay Akinci[Show abstract] [Hide abstract]
ABSTRACT: Cauda equina syndrome is a neurological disorder defined by urinary and/or anal sphincter dysfunction, bilateral sciatica and bilateral motor and sensory deficits. Regarding the etiology, lumbar disc disease, spinal stenosis, tumors, haematomas, fractures, infectious diseases and ankylosing spondylitis are pathologies causing this syndrome. Spinal epidural haematomas are common amongst complications after spinal surgery. However the majority of these cases are asymptomatic, thus having little clinical importance. Symptomatic postoperative spinal epidural hae - matomas is a serious complication, and in order to prevent permanent neurologic deficit it requires urgent surgical intervention. This article aims to present the case of a patient with a spinal epidural haematoma after spinal stenosis surgery, causing cauda equina syndrome.Journal of Clinical and Analytical Medicine. 05/2014;
- [Show abstract] [Hide abstract]
ABSTRACT: Object Patients who develop a lower-extremity neurological deficit after lumbar laminectomy present a diagnostic dilemma. In the setting of a neurological deficit, some surgeons use MRI to evaluate for symptomatic compression of the thecal sac. The authors conducted a prospective observational cohort study in patients undergoing open lumbar laminectomy for neurogenic claudication to document the MRI appearance of the postlaminectomy spine and to determine changes in thecal sac diameter caused by the accumulation of epidural fluid. Methods Eligible patients who were candidates for open lumbar laminectomy for neurogenic claudication at a single neurosurgical center between August 2007 and June 2009 were enrolled. Preoperative and postoperative MRI of the lumbar spine was performed on the same MRI scanner. Postoperative MRI studies were completed within 36 hours of surgery. Routine clinical and surgical data were collected at the preoperative visit, during surgery, and postoperatively. Images were interpreted for the signal characteristics of the epidural fluid and for thecal diameter (region of interest [ROI]) by 2 blinded neuroradiologists. Results Twenty-four patients (mean age 69.7 years, range 30-83 years) were enrolled, and 20 completed the study. Single-level laminectomy was performed in 6 patients, 2-level in 12, and 3-level in 2. Preoperative canal measurements (ROI) at the most stenotic level averaged 0.26 cm(2) (range 0.0-0.46 cm(2)), and postoperative ROI at that same level averaged 0.95 cm(2) (range 0.46-2.05 cm(2)). The increase in ROI averaged 0.69 cm(2) (range 0.07-1.81 cm(2)). Seven patients (35%) had immediate postoperative weakness in at least 1 muscle group graded at 4+/5. The decline in examination was believed to be effort dependent and secondary to discomfort in the acute postoperative period. Those with weakness had smaller increases in ROI (0.51 cm(2)) than those with full strength (0.78 cm(2), p = 0.1599), but none had evidence of worsened thecal compression. On the 1st postoperative day, 19 patients were at full strength and all patients were at full strength at their 15-day follow-up. The T1-weighted epidural fluid signal was isointense in 19 of the 20 patients. The T2-weighted epidural fluid signal was hyperintense in 9, isointense in 4, and hypointense in 7 patients. Conclusions Immediately after lumbar laminectomy, the appearance of the thecal sac on MRI can vary widely. In most patients the thecal sac diameter increases after laminectomy despite the presence of epidural blood. In this observational cohort, a reduction in thecal diameter caused by epidural fluid did not correlate with motor function. Results in the small subset of patients where the canal diameter decreased due to epidural fluid compression of the thecal sac raises the question of the utility of immediate postoperative MRI.Journal of neurosurgery. Spine 10/2013; · 1.61 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Unaffected wound healing and good cosmetic result after a neurosurgical procedure are important factors measuring a level of care. The usefulness of high magnification of the operating microscope during closure of neurosurgical wounds is evaluated. During a one-year microneurosurgical fellowship, the first author (JK) performed wound closure under the microscope in 200 of 524 neurosurgical operations carried out by the senior author (JH) at the Department of Neurosurgery, Helsinki University Central Hospital. Supratentorial approaches were employed most frequently in 143 patients (72%). Surgeries for infratentorial lesions and the spinal canal comprised 48 (24%) and 9 procedures (4%), respectively. Mean duration of the surgery from skin to skin was 1.8 (range 0.5-6.2) hours. After intradural hemostasis was completed by the senior author, further steps including dural suturing, bone flap fixation, and wound closure were performed by the first author. Wound condition was assessed during the early and late postoperative period. Mean follow-up was 3.2 (range 1-10) months. Early postoperative healing of the wound was uneventful in 180 patients (90%). No wound rupture or postoperative hematoma occurred. In five patients (2.5%), lumbar puncture or spinal drainage was necessary due to significant subcutaneous liquor collection. No wound revision was required. At follow-up, in 196 patients (98%) the postoperative scar was in perfect condition. Neither skin necrosis nor healing problems occurred. Based on our results, we found the high magnification of operating microscope to be beneficial when closing neurosurgical wounds; it allows (1) better hemostasis, (2) precise wound margin approximation, (3) atraumatic handling of the tissues, and (4) improvement of the manual dexterity of the neurosurgeon.Surgical Neurology International 01/2013; 4:115. · 1.18 Impact Factor