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

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

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References

  1. Yonenobu K, Hosono N, Iwasaki M et al (1991) Neurologic complications of surgery for cervical compression myelopathy. Spine (Phila Pa 1976) 16:1277–1282

    Article  CAS  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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. 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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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 18:662–664

    Google Scholar 

  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)

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  14. Kou J, Fischgrund J, Biddinger A, Herkowitz H (2002) Risk factors for spinal epidural hematoma after spinal surgery. Spine (Phila Pa 1976) 27:1670–1673

    Article  CAS  Google Scholar 

  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

    Article  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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 81:107–117

    Article  PubMed  Google Scholar 

  18. Payne DH, Fischgrund JS, Herkowitz HN et al (1996) Efficacy of closed wound suction drainage after single-level lumbar laminectomy. J Spinal Disord 9:401–403

    Article  CAS  PubMed  Google Scholar 

  19. Brown MD, Brookfield KFW (2004) A randomized study of closed wound suction drainage for extensive lumbar spine surgery. Spine (Phila Pa 1976) 29:1066–1068

    Article  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We appreciate Mr. Vincent Hykel for his devoted support.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabe-Minami, Asa-kita-ku, Hiroshima, Hiroshima, 731-0293, Japan

    Yasushi Fujiwara, Hideki Manabe, Bunichiro Izumi & Takahiro Harada

  2. Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan

    Kazuyoshi Nakanishi, Nobuhiro Tanaka & Nobuo Adachi

Authors
  1. Yasushi Fujiwara
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  2. Hideki Manabe
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  3. Bunichiro Izumi
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  4. Takahiro Harada
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  5. Kazuyoshi Nakanishi
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  6. Nobuhiro Tanaka
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  7. Nobuo Adachi
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Correspondence to Yasushi Fujiwara.

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Fujiwara, Y., Manabe, H., Izumi, B. et al. The impact of hypertension on the occurrence of postoperative spinal epidural hematoma following single level microscopic posterior lumbar decompression surgery in a single institute. Eur Spine J 26, 2606–2615 (2017). https://doi.org/10.1007/s00586-017-5165-9

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  • DOI: https://doi.org/10.1007/s00586-017-5165-9

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