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Symptomatic Epidural Hematoma after Elective Posterior Lumbar Decompression: Incidence, Timing, Risk Factors, and Associated Complications

  • Original Article
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HSS Journal ®

Abstract

Background

Symptomatic post-operative lumbar epidural hematoma (PLEH) is a complication of lumbar spine surgery that can cause permanent neurologic consequences through compression of the cauda equina and nerve roots.

Questions/Purposes

We sought to investigate the incidence, timing, and risk factors for symptomatic epidural hematomas following posterior lumbar decompression, as well as to identify additional post-operative complications associated with symptomatic lumbar epidural hematomas.

Methods

Elective lumbar spine procedures were identified in the National Surgical Quality Improvement Program (NSQIP) database between 2012 and 2016. Analyzed predictors of reoperation or readmission within 30 days for symptomatic PLEH included demographics, comorbidities, pre-operative laboratory values, peri-operative characteristics, and post-operative complications.

Results

There were 75,878 cases included in the analysis. The incidence rate of symptomatic PLEH was 0.27% (n = 206), 54.4% (n = 112) of which occurred within 5 days of the procedure. Increased age, obesity (body mass index of 35 or higher), peri-operative transfusion, multilevel surgery (two or more levels), dural tear repair, and microscope use were independently associated with PLEH. Post-operative complications associated with PLEH included surgical site infection and urinary tract infection.

Conclusions

Readmission or reoperation for symptomatic PLEH following elective lumbar spine surgery is rare and can occur many days or weeks after a procedure. There are modifiable risk factors for PLEH and associated additional post-operative complications that physicians should be suspicious of following posterior lumbar decompression.

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Authors and Affiliations

  1. Case Western Reserve University School of Medicine, 2109 Adelbert Road, Cleveland, OH, 44106, USA

    Konrad Knusel MS & Bryan Ren BS

  2. University Hospitals/Cleveland Medical Center Department of Orthopedics, 11100 Euclid Avenue, Cleveland, OH, 44106, USA

    Jerry Y. Du MD, Chang-Yeon Kim MD, MS & Nicholas U. Ahn MD

  3. MetroHealth Medical Center, 2500 MetroHealth Dr., Cleveland, OH, 44109, USA

    Jerry Y. Du MD

  4. New Hampshire NeuroSpine Institute, 4 Hawthorne Dr, Bedford, NH, 03110, USA

    Uri M. Ahn MD

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  1. Konrad Knusel MS
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Correspondence to Konrad Knusel MS.

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Konrad Knusel MS, Jerry Y. Du MD, Bryan Ren BS, Chang-Yeon Kim MD, MS, Uri M. Ahn MD, Nicholas U. Ahn MD, declare that they have no conflicts of interest.

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Knusel, K., Du, J.Y., Ren, B. et al. Symptomatic Epidural Hematoma after Elective Posterior Lumbar Decompression: Incidence, Timing, Risk Factors, and Associated Complications. HSS Jrnl 16 (Suppl 2), 230–237 (2020). https://doi.org/10.1007/s11420-019-09690-2

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  • DOI: https://doi.org/10.1007/s11420-019-09690-2

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