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Prognostic factors and surgical outcomes of spontaneous spinal epidural haematoma: a systematic review and meta-analysis

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Abstract

Spontaneous spinal epidural haematoma (SSEH) is a rare disease defined as blood accumulation within the vertebral epidural space without a cause identified, which can lead to severe neurological deficits. We aim to provide a comprehensive understanding of the prognostic factors affecting surgical outcomes in true SSEH and propose a critical time frame for operative management. A systematic literature search was performed and registered, using OVID Medline and EMBASE, in line with the PRISMA guidelines. Relevant demographic, clinical, surgical, and outcome data were extracted. The ASIA scale was uniformly used throughout our systematic review. Statistical analysis was performed via logistic regression. Of the 1179 articles examined, we included 181 studies involving 295 adult patients surgically treated for SSEH. SSEH were most commonly found in the cervicothoracic spine, with 2–4 spinal segments most commonly involved. Multivariable logistic regression model showed that the following factors were statistically significant in the post-operative outcome: operation type (P = 0.024), pre-operative neurologic status (P < 0.001), use of warfarin (P = 0.039), and operative interval (P = 0.006). Our retrospective analysis confirms the reversibility of severe neurological deficits after surgical intervention, with a prognosis of post-operative outcomes determined by the use of warfarin, pre-operative ASIA grade, and above all surgical evacuation within 12 h.

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  1. Amisha Vastani, Asfand Baig Mirza, and Abbas Khizar Khoja have contributed equally to the manuscript

Authors and Affiliations

  1. Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London, SE5 9RS, UK

    Amisha Vastani, Asfand Baig Mirza, Abbas Khizar Khoja, James Bartram, Safwan Shaheen, Shivani Rajkumar, Jose Pedro Lavrador, Cristina Bleil, David Bell, Nick Thomas, Irfan Malik & Gordan Grahovac

  2. Division of Medicine, University College London (UCL), London, UK

    Musa China

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  1. Amisha Vastani
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Contributions

A.V, A.B.M, and A.K.K wrote the main manuscript.

A.K.K performed the statistical analysis.

A.V, A.B.M, S.R, and S.S performed the systematic review.

J.B and M.C prepared the figures and tables alongside reviewing the manuscript.

G.G, I.M, C.B, D.B, and N.T—senior supervision and critical review of the manuscript.

All authors reviewed the manuscript.

Corresponding author

Correspondence to Amisha Vastani.

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Supplementary Information

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10143_2022_1914_MOESM1_ESM.docx

Supplementary file1 (DOCX 15 kb) Supplementary Table 1 Variables eligible for inclusion in statistical analysis. Abbreviations: ASIA – American Spinal Injury Association; HIV – human immunodeficiency virus; BMI – body mass index; CVA – cerebrovascular accident; TIA – transient ischaemic attack; GI – gastrointestinal; DVT – deep vein thrombosis; PE – pulmonary embolism; DOAC – direct oral anticoagulant; NOAC – novel oral anticoagulant

10143_2022_1914_MOESM2_ESM.docx

Supplementary file2 (DOCX 17 kb) Supplementary Table 2 Alternate reference value comparisons for polytomous variables. Bold figures < 0.05 (statistically significant). Abbreviations: ASIA – American Spinal Injury Association

10143_2022_1914_MOESM3_ESM.docx

Supplementary file3 (DOCX 27 kb) Supplementary Table 3 Results of subgroup statistical analysis of Univariate and multivariate logistic regression of risk factors for patients with pre-operative ASIA A. Abbreviations: CI = confidence interval; OR = odds ratio; SE = standard error; ASIA = American Spinal Injury Association; CT = computed tomography; MRI = magnetic resonance imaging. aOdds ratio of 1 indicates reference group, *Indicates variables with a statistically significant effect on the outcome (post-operative ASIA grade)

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Vastani, A., Baig Mirza, A., Khoja, A.K. et al. Prognostic factors and surgical outcomes of spontaneous spinal epidural haematoma: a systematic review and meta-analysis. Neurosurg Rev 46, 21 (2023). https://doi.org/10.1007/s10143-022-01914-0

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