Epidural hematoma following cervical Spine surgery

Gregory D. Schroeder*, Alan S. Hilibrand, Paul M. Arnold, David E. Fish, Jeffrey C. Wang, Jeffrey L. Gum, Zachary A. Smith, Wellington K. Hsu, Ziya L. Gokaslan, Robert E. Isaacs, Adam S. Kanter, Thomas E. Mroz, Ahmad Nassr, Rick C. Sasso, Michael G. Fehlings, Zorica Buser, Mohamad Bydon, Peter I. Cha, Dhananjay Chatterjee, Erica L. GeeElizabeth L. Lord, Erik N. Mayer, Owen J. McBride, Emily C. Nguyen, Allison K. Roe, P. Justin Tortolani, D. Alex Stroh, Marisa Y. Yanez, K. Daniel Riew

*Corresponding author for this work

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Study Design: A multicentered retrospective case series. Objective: To determine the incidence and circumstances surrounding the development of a symptomatic postoperative epidural hematoma in the cervical spine. Methods: Patients who underwent cervical spine surgery between January 1, 2005, and December 31, 2011, at 23 institutions were reviewed, and all patients who developed an epidural hematoma were identified. Results: A total of 16 582 cervical spine surgeries were identified, and 15 patients developed a postoperative epidural hematoma, for a total incidence of 0.090%. Substantial variation between institutions was noted, with 11 sites reporting no epidural hematomas, and 1 site reporting an incidence of 0.76%. All patients initially presented with a neurologic deficit. Nine patients had complete resolution of the neurologic deficit after hematoma evacuation; however 2 of the 3 patients (66%) who had a delay in the diagnosis of the epidural hematoma had residual neurologic deficits compared to only 4 of the 12 patients (33%) who had no delay in the diagnosis or treatment (P =.53). Additionally, the patients who experienced a postoperative epidural hematoma did not experience any significant improvement in health-related quality-of-life metrics as a result of the index procedure at final follow-up evaluation. Conclusion: This is the largest series to date to analyze the incidence of an epidural hematoma following cervical spine surgery, and this study suggest that an epidural hematoma occurs in approximately 1 out of 1000 cervical spine surgeries. Prompt diagnosis and treatment may improve the chance of making a complete neurologic recovery, but patients who develop this complication do not show improvements in the health-related quality-of-life measurements.

Original languageEnglish (US)
Pages (from-to)120S-126S
JournalGlobal Spine Journal
Volume7
Issue number1_suppl
DOIs
StatePublished - Apr 1 2017

Keywords

  • ACDF
  • anterior cervical discectomy and fusion
  • cervical spine surgery
  • complications
  • epidural hematoma
  • posterior cervical
  • postoperative epidural hematoma

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

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    Schroeder, G. D., Hilibrand, A. S., Arnold, P. M., Fish, D. E., Wang, J. C., Gum, J. L., Smith, Z. A., Hsu, W. K., Gokaslan, Z. L., Isaacs, R. E., Kanter, A. S., Mroz, T. E., Nassr, A., Sasso, R. C., Fehlings, M. G., Buser, Z., Bydon, M., Cha, P. I., Chatterjee, D., ... Riew, K. D. (2017). Epidural hematoma following cervical Spine surgery. Global Spine Journal, 7(1_suppl), 120S-126S. https://doi.org/10.1177/2192568216687754