Causes and preventive measures of symptomatic spinal epidural haematoma after spinal surgery.

Study Design: This was a retrospective study to evaluate clinical characteristics of patients who developed symptomatic spinal epidural haematoma (SSEH) after spinal surgery.

Objective: The objective was to determine clinical parameters associated with the development of SSEH after spinal surgery, and to discuss clinical management and possible preventive measures. Although the incidence rate of SSEH is low, the neurological sequelae are devastating. There are limited reports which identify risk factors for SSEH because of the rarity of the condition.

Methods: The 4,457 cases of spine operations performed in two medical centres were reviewed. Eleven of the cases developed postoperative spinal epidural haematomas, causing neurologic deterioration. The clinical manifestations of these 11 cases were described, and factors associated with the recovery of neurologic function were evaluated.

Results: The causes of SSEH following spinal surgery included inadequate drainage (9 cases), administration of anticoagulants (6 cases) and complicated coagulation disorders (1 case). The main clinical manifestation was progressive neurological deterioration in the innervated area. Seven cases underwent MRI examination and compressions of dural sac and spinal cord were observed. High pressure haematomas were found in eight cases during haematoma evacuation. Statistical analyses showed that patients with mild nerve injury at the initial stage were associated with better recovery (P<0.05). Patients who recovered completely had shorter symptom duration on average.

Conclusions: Post-operative bleeding in the wound and inadequate drainage are the primary causes of SSEH. The severity of neurologic injury before haematoma evacuation was associated with the treatment outcome; therefore, it is important to have early diagnosis of SSEH to prevent progression of the neurologic injury.