European Spine Journal

, Volume 26, Issue 10, pp 2606–2615 | Cite as

The impact of hypertension on the occurrence of postoperative spinal epidural hematoma following single level microscopic posterior lumbar decompression surgery in a single institute

  • Yasushi Fujiwara
  • Hideki Manabe
  • Bunichiro Izumi
  • Takahiro Harada
  • Kazuyoshi Nakanishi
  • Nobuhiro Tanaka
  • Nobuo Adachi
Original Article



Postoperative spinal epidural hematoma (PSEH) is one of the most hazardous complications after spine surgery. A recent study has reported that a ≥50 mmHg increase in systolic blood pressure after extubation was a significant risk factor for symptomatic PSEH. In this paper, the impact of hypertension on PSEH occurrence was investigated.


Among a total of 2468 patients who underwent single level microscopic posterior decompression surgery for lumbar spinal stenosis in a single institute, 15 (0.6%) received evacuation surgery for PSEH. Those 15 patients were investigated statistically compared with a randomly selected control group (n = 46) using the Mann–Whitney U test and multiple logistic regression analysis.


The univariate analysis showed that there were no significant differences in age, gender, BMI, pre-operative anti-coagulant usage, intraoperative blood loss, operation time, and the rate of patients who received pre-operative hypertension treatment. However, there were significant differences in the rate of patients who showed high blood pressure at admission (66.7 vs 6.5%) and >50 mmHg increases in blood pressure after extubation (53.3 vs 17.4%) in the univariate analysis. Moreover, postoperatively, there was a statistical difference in the amount of post-operative drainage. Multiple logistic regression analysis showed that high blood pressures at admission and poor postoperative drainage were the essential risk factors.


Our results demonstrate that the pre-operative high blood pressure value was the most essential risk factor for PSEH, although there was no difference in the preoperative hypertension treatment. Consequently, management of pre-operative blood pressure and post-operative drainage will be crucial for preventing PSEH.


Spine surgery Spinal epidural hematoma Surgical complications 



We appreciate Mr. Vincent Hykel for his devoted support.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interest.


  1. 1.
    Yonenobu K, Hosono N, Iwasaki M et al (1991) Neurologic complications of surgery for cervical compression myelopathy. Spine (Phila Pa 1976) 16:1277–1282CrossRefGoogle Scholar
  2. 2.
    Ikuta K, Tono O, Tanaka T et al (2006) Evaluation of postoperative spinal epidural hematoma after microendoscopic posterior decompression for lumbar spinal stenosis: a clinical and magnetic resonance imaging study. J Neurosurg Spine 5:404–409. doi: 10.3171/spi.2006.5.5.404 CrossRefPubMedGoogle Scholar
  3. 3.
    Glotzbecker MP, Bono CM, Wood KB, Harris MB (2010) Postoperative spinal epidural hematoma: a systematic review. Spine (Phila Pa 1976) 35:E413–E420. doi: 10.1097/BRS.0b013e3181d9bb77 CrossRefGoogle Scholar
  4. 4.
    Lawton MT, Porter RW, Heiserman JE et al (1995) Surgical management of spinal epidural hematoma: relationship between surgical timing and neurological outcome. J Neurosurg 83:1–7. doi: 10.3171/jns.1995.83.1.0001 CrossRefPubMedGoogle Scholar
  5. 5.
    Yamada K, Abe Y, Satoh S et al (2015) Large increase in blood pressure after extubation and high body mass index increase the risk of spinal epidural hematoma after spinal surgery. Spine (Phila Pa 1976). doi: 10.1097/BRS.0000000000000876 Google Scholar
  6. 6.
    Amiri AR, Fouyas IP, Cro S, Casey ATH (2013) Postoperative spinal epidural hematoma (SEH): incidence, risk factors, onset, and management. Spine J 13:134–140. doi: 10.1016/j.spinee.2012.10.028 CrossRefPubMedGoogle Scholar
  7. 7.
    Modi HN, Lee DY, Lee S-H (2011) Postoperative spinal epidural hematoma after microscopic lumbar decompression: a prospective magnetic resonance imaging study in 89 patients. J Spinal Disord Tech 24:146–150. doi: 10.1097/BSD.0b013e3181e1958e CrossRefPubMedGoogle Scholar
  8. 8.
    Awad JN (2005) Analysis of the risk factors for the development of post-operative spinal epidural haematoma. J Bone Jt Surg Br 87-B:1248–1252. doi: 10.1302/0301-620X.87B9.16518 CrossRefGoogle Scholar
  9. 9.
    Kao F-C, Tsai T-T, Chen L-H et al (2015) Symptomatic epidural hematoma after lumbar decompression surgery. Eur Spine J 24:348–357. doi: 10.1007/s00586-014-3297-8 CrossRefPubMedGoogle Scholar
  10. 10.
    Sumida T, Manabe H, Kobayashi K et al (2007) Semi-circumferential decompression (SCD): microscopic posterior decompression for lumbar spine. J Jpn Soc Spine Surg Relat Res 18:662–664Google Scholar
  11. 11.
    Fujiwara Y, Manabe H, Sumida T et al (2017) Facet preserving technique by en bloc flavectomy in microscopic posterior decompression surgery for lumbar spinal stenosis semicircumferential decompression (SCD). Clin Spine Surg. (In publish)Google Scholar
  12. 12.
    Aono H, Ohwada T, Hosono N et al (2011) Incidence of postoperative symptomatic epidural hematoma in spinal decompression surgery. J Neurosurg Spine 15:202–205. doi: 10.3171/2011.3.SPINE10716 CrossRefPubMedGoogle Scholar
  13. 13.
    Goldstein CL, Bains I, Hurlbert RJ (2015) Symptomatic spinal epidural hematoma after posterior cervical surgery: incidence and risk factors. Spine J 15:1179–1187. doi: 10.1016/j.spinee.2013.11.043 CrossRefPubMedGoogle Scholar
  14. 14.
    Kou J, Fischgrund J, Biddinger A, Herkowitz H (2002) Risk factors for spinal epidural hematoma after spinal surgery. Spine (Phila Pa 1976) 27:1670–1673CrossRefGoogle Scholar
  15. 15.
    Sokolowski MJ, Garvey TA, Perl J et al (2008) Prospective study of postoperative lumbar epidural hematoma: incidence and risk factors. Spine (Phila Pa 1976) 33:108–113. doi: 10.1097/BRS.0b013e31815e39af CrossRefGoogle Scholar
  16. 16.
    Mirzai H, Eminoglu M, Orguc S (2006) Are drains useful for lumbar disc surgery? A prospective, randomized clinical study. J Spinal Disord Tech 19:171–177. doi: 10.1097/01.bsd.0000190560.20872.a7 CrossRefPubMedGoogle Scholar
  17. 17.
    de Simone G, Devereux RB, Chien S et al (1990) Relation of blood viscosity to demographic and physiologic variables and to cardiovascular risk factors in apparently normal adults. Circulation 81:107–117CrossRefPubMedGoogle Scholar
  18. 18.
    Payne DH, Fischgrund JS, Herkowitz HN et al (1996) Efficacy of closed wound suction drainage after single-level lumbar laminectomy. J Spinal Disord 9:401–403CrossRefPubMedGoogle Scholar
  19. 19.
    Brown MD, Brookfield KFW (2004) A randomized study of closed wound suction drainage for extensive lumbar spine surgery. Spine (Phila Pa 1976) 29:1066–1068CrossRefGoogle Scholar
  20. 20.
    Kanayama M, Oha F, Togawa D et al (2010) Is closed-suction drainage necessary for single-level lumbar decompression? Review of 560 cases. Clin Orthop Relat Res 468:2690–2694. doi: 10.1007/s11999-010-1235-6 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryHiroshima City Asa Citizens HospitalHiroshimaJapan
  2. 2.Department of Orthopaedic SurgeryGraduate School of Biomedical Sciences, Hiroshima UniversityHiroshimaJapan

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