Email Alert | RSS

Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (6): 1058-1064. doi: 10.19723/j.issn.1671-167X.2024.06.018

Previous Articles     Next Articles

Incidence and risk factors of postoperative epidural hematoma following anterior cervical spine surgery

Yang TIAN1, Yongzheng HAN1, Jiao LI1, Mingya WANG1, Yinyin QU1, Jingchao FANG2, Hui JIN3, Min LI1, Jun WANG1, Mao XU1, Shenglin WANG4, Xiangyang GUO1,*()   

  1. 1. Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China
    2. Department of Radiology, Peking University Third Hospital, Beijing 100191, China
    3. Department of Anesthesiology, The First Affiliated Hospital of Hainan Medical College, Haikou 570102, China
    4. Department of Orthopaedics, Peking University Third Hospital, Beijing 100191, China
  • Received:2024-06-11 Online:2024-12-18 Published:2024-12-18
  • Contact: Xiangyang GUO E-mail:puthmzk@163.com
  • Supported by:
    Capital's Funds for Health Improvement and Research(2024-2-40912)

RICH HTML

   

PDF (PC)

Abstract:

Objective: To investigate the incidence and potential risk factors associated with postoperative spinal epidural hematoma (SEH) following anterior cervical spine surgery (ACSS). Methods: A retrospective analysis was conducted on the clinical data of patients who underwent ACSS for cervical spondylosis at Peking University Third Hospital between March 2013 and February 2022. Patients who developed postoperative SEH were categorized as the SEH group, while those in the cohort without SEH were randomly selected as the non-SEH group by individually matching with the same operator, same gender, same surgery year, and similar age (±5 years) at a ratio of 4 ∶ 1. The general condition, preoperative comorbidities, anticoagulant or antiplatelet therapy, preoperative coagulation and platelet counts, American society of Anesthesiologists physical status classification, cervical spondylosis classification, preoperative modified Japanese Orthopaedic Society score and cervical disability index score, surgical modality, surgical segment levels, ossification of the posterior longitudinal ligament among the surgical level, surgery duration, estimated blood loss, postoperative drainage volume, preoperative mean arterial pressure, mean arterial pressure during postoperative awakening periods, hospital stay and hospitalization cost were compared between the two groups. A bivariate Logistic regression model was applied to screen out the independent risk factors and calculate the odds ratios of indicators associated with SEH. Receiver operating characteristic curve and area under the curve (AUC) were used to describe the discrimination ability of the indicators. Results: A total of 85 patients were enrolled in the study, including 17 patients in the SEH group and 68 patients in the non-SEH group. Seventeen patients with SEH underwent hematoma evacuation, and all of them were successfully treated and discharged from the hospital. Corpectomy (OR=7.247; 95%CI: 1.962-26.766; P=0.003) and the highest mean arterial pressure during awakening (OR=1.056; 95%CI: 1.002-1.113; P=0.043) were independent risk factors for SEH. The AUC values were 0.713 (95%CI: 0.578-0.848) and 0.665 (95%CI: 0.51-0.82) respectively. The patients with SEH had longer hospital stays (P < 0.001) and greater hospitalization costs (P=0.035). Conclusion: Corpectomy and elevated maximum mean arterial pressure during awakening are independent risk factors for the development of postoperative SEH following ACSS. High-risk patients should be closely monitored during the perioperative period.

Key words: Anterior cervical spine surgery, Spinal epidural hematoma, Risk factors

CLC Number: 

  • R681.55

Table 1

Characteristics of SEH group"

Case number Symptom Symptom onset time Diagnostic method Time from symptom onset to evacuation Outcome
1 Quadriplegia 2 h Clinical examination 0.5 h Resolved
2 Quadriplegia 1 h MRI 2.5 h Resolved
3 Quadriplegia 1 h Clinical examination 1 h Resolved
4 Numbness 7 d MRI 6 d Resolved
5 Significant pain in left hand 1 h CT 0.5 h Resolved
6 Numbness 2 h MRI 8 h Resolved
7 Quadriplegia 3 h Clinical examination 2 h Resolved with residual neurologic deficits (mild motor weakness)
8 Quadriplegia 12 h Clinical examination 1 h Resolved
9 Sensory disorder and weakness in right upper limb 5 d MRI and CT 2 d Unresolved
10 Quadriplegia 3 h MRI and CT 2.5 h Resolved
11 Quadriplegia 4 h Clinical examination 0.5 h Resolved with residual neurologic deficits (mild motor weakness)
12 Paraplegia 2 h Clinical examination 2.5 h Resolved with residual neurologic deficits (mild motor weakness)
13 Quadriplegia 2 h Clinical examination 1 h Resolved
14 Weakness in left upper limb 20 h MRI 8 h Resolved with residual neurologic deficits (mild motor weakness)
15 Paraplegia 3 h Clinical examination 1 h Resolved
16 Paraplegia 1 h Clinical examination 2 h Resolved with residual neurologic deficits (mild motor weakness)
17 Paraplegia 0.5 h Clinical examination 0.5 h Resolved

Table 2

Comparison of demographic characteristics between SEH group and non-SEH group"

Characteristic SEH group (n=17) Non-SEH group (n=68) χ2/Z/t P value
Gender, n (%) χ2=0.000 >0.999
  Male 13 (76.5) 52(76.5)
  Female 4 (23.5) 16(23.5)
Age/years, $\bar x \pm s$ 53±10 53±9 t=0.116 0.908
Hypertension, n (%) 4 (23.5) 21(30.9) χ2=0.089 0.766
Body mass index/(kg/m2), $\bar x \pm s$ 26.2±3.2 24.9±3.8 t=-1.239 0.219
Smoking history, n (%) 7 (41.2) 21(30.9) χ2=0.652 0.419
Anticoagulant or antiplatelet therapy, n (%) 1 (5.9) 6(8.8) χ2=0.000 >0.999
ASA classification, n (%) >0.999#
  Ⅰ-Ⅱ 17 (100.0) 65 (95.6)
  ≥Ⅲ 0 (0) 3 (4.4)
Preoperative blood index
  Prothrombin time/s, $\bar x \pm s$ 10.9±0.9 10.9±0.7 t=0.039 0.969
  International normalized ratio, $\bar x \pm s$ 1.02±0.79 1.02±0.06 t=0.176 0.860
  Fibrinogen/(g/L)，$\bar x \pm s$ 3.11±0.63 2.91±0.53 t=-1.329 0.187
  Activated partial thromboplastin time/s, $\bar x \pm s$ 33.2±4.1 31.7±3.1 t=-1.615 0.109
  Thrombin time/s, $\bar x \pm s$ 14.0±1.2 14.0±0.9 t=-0.098 0.921
  Platelet counts/(×109/L), M (IQR) 255 (58) 220 (67) Z=1.719 0.086

Table 3

Comparison of disease, surgery, and anesthesia related factors between SEH group and non-SEH group"

Characteristic SEH group (n=17) Non-SEH group (n=68) χ2/Z/t P value
Classification of cervical spondylosis, n (%) χ2=5.379 0.146
  Cervical spondylotic myelopathy 14 (82.4) 39 (57.4)
  Cervical spondylotic radiculopathy 0 (0) 14 (20.6)
  Mixed cervical spondylosis 3 (17.6) 13 (19.1)
  Other types 0 (0) 2 (2.9)
m-JOA score, M (IQR) 13.5 (3.9) 14.5 (3.5) Z=-1.292 0.196
Neck disability index score, M (IQR) 10.5 (15.8) 10.0 (17.3) Z=-0.049 0.961
Surgical segments, M (IQR) 2 (0.5) 2 (1.0) Z=1.305 0.192
OPLL among the surgical level, n (%) 9 (52.9) 22 (32.4) χ2=2.488 0.115
Corpectomy, n (%) 13 (76.5) 23 (33.8) χ2=8.460 0.004
Surgery duration/min, M (IQR) 95 (40) 86 (52) Z=0.868 0.385
Estimated blood loss/mL, M (IQR) 60 (95) 20 (35) Z=2.889 0.004
Drain volume/mL, M (IQR) 18 (50) 30 (35) Z=-1.063 0.288
Preoperative MAP/mmHg, ±s 97±9 95±10 t=-0.848 0.399
Maximum MAP during awakening/mmHg, M (IQR) 116 (18) 103 (21) Z=2.101 0.036
Length of stay/d, M (IQR) 7 (4) 4 (2) Z=3.536 < 0.001
Cost/yuan, M (IQR) 69 949 (28 116) 60 007 (21 208) Z=2.104 0.035

Table 4

Bivariate Logistic regression (Back-Wald) analysis of the risk factors for SEH"

Variable B SE P value OR 95%CI
Corpectomy 1.981 0.667 0.003 7.247 1.962-26.766
Maximum MAP during awakening 0.054 0.027 0.043 1.056 1.002-1.113
Constant -8.335 3.057 0.006 0

Table 5

Predictive values of risk factors for predicting SEH"

Variable AUC SE P value 95%CI
Corpectomy 0.713 0.069 0.007 0.578-0.848
Maximum MAP during awakening 0.665 0.079 0.036 0.510-0.820
1 Deora H , Kim SH , Behari S , et al.Anterior surgical techniques for cervical spondylotic myelopathy: WFNS spine committee recommendations[J].Neurospine,2019,16(3):408-420.
doi: 10.14245/ns.1938250.125
2 Epstein N .Frequency, recognition, and management of postoperative hematomas following anterior cervical spine surgery: A review[J].Surg Neurol Int,2020,11,356.
doi: 10.25259/SNI_669_2020
3 Liao Y , Tian Y , Ye R , et al.Risk and treatment of symptomatic epidural hematoma after anterior cervical spine surgery: A retrospective clinical study[J].Medicine (Baltimore),2020,99(2):e18711.
doi: 10.1097/MD.0000000000018711
4 Xia T , Zhou F , Chu H , et al.Incidence and risk factors of postoperative symptomatic spinal epidural hematoma in cervical spine surgery: A single center, retrospective study of 18 220 patients[J].Eur Spine J,2022,31(10):2753-2760.
doi: 10.1007/s00586-022-07301-z
5 Amiri AR , Fouyas IP , Cro S , et al.Postoperative spinal epidural hematoma (SEH): Incidence, risk factors, onset, and management[J].Spine J,2013,13(2):134-140.
doi: 10.1016/j.spinee.2012.10.028
6 Aono H , Ohwada T , Hosono N , et al.Incidence of postoperative symptomatic epidural hematoma in spinal decompression surgery[J].J Neurosurg Spine,2011,15(2):202-205.
doi: 10.3171/2011.3.SPINE10716
7 齐昊, 顾运涛, 许春召, 等.颈椎前路椎管减压术后并发早期硬膜外血肿的临床研究[J].实用骨科杂志,2023,29(6):481-486.
8 Yin G , Ni B .Acute postoperative cervical spinal epidural hematoma[J].Acta Orthop Traumatol Turc,2014,48(4):437-442.
doi: 10.3944/AOTT.2014.13.0133
9 Schroeder GD , Hilibrand AS , Arnold PM , et al.Epidural hematoma following cervical spine surgery[J].Global Spine J,2017,7(Suppl 1):120s-126s.
10 Xu W , Guo J , Zhu J , et al.Delayed postoperative spinal epidural hematoma after anterior cervical discectomy and fusion: A case report[J].Front Surg,2022,9,1005462.
doi: 10.3389/fsurg.2022.1005462
11 Hohenberger C , Zeman F , Höhne J , et al.Symptomatic post-operative spinal epidural hematoma after spinal decompression surgery: Prevalence, risk factors, and functional outcome[J].J Neurol Surg A Cent Eur Neurosurg,2020,81(4):290-296.
doi: 10.1055/s-0039-1697024
12 Epstein NE , Agulnick MA .Perspective: Postoperative spinal epidural hematomas (pSEH) should be treated, not ignored[J].Surg Neurol Int,2023,14,363.
doi: 10.25259/SNI_772_2023
13 Henderson RD , Pittock SJ , Piepgras DG , et al.Acute sponta-neous spinal epidural hematoma[J].Arch Neurol,2001,58(7):1145-1146.
doi: 10.1001/archneur.58.7.1145
14 Hao Q , Ding Q , Yang H , et al.Symptomatic postoperative spinal epidural hematoma preferentially occurs after anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion: A retrospective study[J].Ann Palliat Med,2022,11(6):2025-2032.
doi: 10.21037/apm-22-488
15 李野, 陈晶, 高忠文, 等.颈椎前路手术后早发性硬膜外血肿的早期诊断和治疗[J].中华骨科杂志,2016,36(17):1076-1084.
16 Liu Z , Jiao Q , Xu J , et al.Spontaneous spinal epidural hematoma: Analysis of 23 cases[J].Surg Neurol,2008,69(3):253-260.
doi: 10.1016/j.surneu.2007.02.019
17 Kao FC , Tsai TT , Chen LH , et al.Symptomatic epidural hematoma after lumbar decompression surgery[J].Eur Spine J,2015,24(2):348-357.
doi: 10.1007/s00586-014-3297-8
18 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[J].Eur Spine J,2017,26(10):2606-2615.
doi: 10.1007/s00586-017-5165-9
19 Yamada K , Abe Y , Satoh S , et al.Large increase in blood pressure after extubation and high body mass index elevate the risk of spinal epidural hematoma after spinal surgery[J].Spine (Phila Pa 1976),2015,40(13):1046-1052.
doi: 10.1097/BRS.0000000000000876
20 Wang L , Wang H , Zeng Y , et al.Delayed onset postoperative spinal epidural hematoma after lumbar spinal surgery: Incidence, risk factors, and clinical outcomes[J].Biomed Res Int,2020,8827962.
21 罗卓荆, 吕国华.脊柱外科围手术期出血防治专家共识[J].中国脊柱脊髓杂志,2021,31(5):475-480.
22 Awad JN , Kebaish KM , Donigan J , et al.Analysis of the risk factors for the development of post-operative spinal epidural haematoma[J].J Bone Joint Surg Br,2005,87(9):1248-1252.
23 Chen Q , Zhong X , Liu W , et al.Incidence of postoperative symptomatic spinal epidural hematoma requiring surgical evacuation: A systematic review and meta-analysis[J].Eur Spine J,2022,31(12):3274-3285.
doi: 10.1007/s00586-022-07421-6
[1] Yukai LI, Hongyan WANG, Liang LUO, Yun LI, Chun LI. Clinical significance of antiphospholipid antibodies in Behcet disease with thrombosis [J]. Journal of Peking University (Health Sciences), 2024, 56(6): 1036-1040.
[2] Mingrui WANG, Jinhui LAI, Jiaxiang JI, Xinwei TANG, Haopu HU, Qi WANG, Kexin XU, Tao XU, Hao HU. Risk factors for decreased quality of life in patients with kidney stones predicted by the Chinese version of Wisconsin stone quality of life questionnaire [J]. Journal of Peking University (Health Sciences), 2024, 56(6): 1069-1074.
[3] Zhicun LI, Tianyu WU, Lei LIANG, Yu FAN, Yisen MENG, Qian ZHANG. Risk factors analysis and nomogram model construction of postoperative pathological upgrade of prostate cancer patients with single core positive biopsy [J]. Journal of Peking University (Health Sciences), 2024, 56(5): 896-901.
[4] Ye YAN,Xiaolong LI,Haizhui XIA,Xuehua ZHU,Yuting ZHANG,Fan ZHANG,Ke LIU,Cheng LIU,Lulin MA. Analysis of risk factors for long-term overactive bladder after radical prostatectomy [J]. Journal of Peking University (Health Sciences), 2024, 56(4): 589-593.
[5] Yan CHEN,Kuangmeng LI,Kai HONG,Shudong ZHANG,Jianxing CHENG,Zhongjie ZHENG,Wenhao TANG,Lianming ZHAO,Haitao ZHANG,Hui JIANG,Haocheng LIN. Retrospective study on the impact of penile corpus cavernosum injection test on penile vascular function [J]. Journal of Peking University (Health Sciences), 2024, 56(4): 680-686.
[6] Bo PANG,Tongjun GUO,Xi CHEN,Huaqi GUO,Jiazhang SHI,Juan CHEN,Xinmei WANG,Yaoyan LI,Anqi SHAN,Hengyi YU,Jing HUANG,Naijun TANG,Yan WANG,Xinbiao GUO,Guoxing LI,Shaowei WU. Personal nitrogen oxides exposure levels and related influencing factors in adults over 35 years old in Tianjin and Shanghai [J]. Journal of Peking University (Health Sciences), 2024, 56(4): 700-707.
[7] Jing HE,Zhongze FANG,Ying YANG,Jing LIU,Wenyao MA,Yong HUO,Wei GAO,Yangfeng WU,Gaoqiang XIE. Relationship between lipid metabolism molecules in plasma and carotid atheroscle-rotic plaques, traditional cardiovascular risk factors, and dietary factors [J]. Journal of Peking University (Health Sciences), 2024, 56(4): 722-728.
[8] Shan CAI,Yihang ZHANG,Ziyue CHEN,Yunfe LIU,Jiajia DANG,Di SHI,Jiaxin LI,Tianyu HUANG,Jun MA,Yi SONG. Status and pathways of factors influencing physical activity time among elementary and junior high school students in Beijing [J]. Journal of Peking University (Health Sciences), 2024, 56(3): 403-410.
[9] Zuhong ZHANG,Tianjiao CHEN,Jun MA. Associations between puberty timing and cardiovascular metabolic risk factors among primary and secondary students [J]. Journal of Peking University (Health Sciences), 2024, 56(3): 418-423.
[10] Yuting LIN,Huali WANG,Yu TIAN,Litong GONG,Chun CHANG. Factors influencing cognitive function among the older adults in Beijing [J]. Journal of Peking University (Health Sciences), 2024, 56(3): 456-461.
[11] Jinrong ZHU,Yana ZHAO,Wei HUANG,Weiwei ZHAO,Yue WANG,Song WANG,Chunyan SU. Clinical characteristics of COVID-19 infection in patients undergoing hemodialysis [J]. Journal of Peking University (Health Sciences), 2024, 56(2): 267-272.
[12] Zhanhong LAI,Jiachen LI,Zelin YUN,Yonggang ZHANG,Hao ZHANG,Xiaoyan XING,Miao SHAO,Yuebo JIN,Naidi WANG,Yimin LI,Yuhui LI,Zhanguo LI. A unicenter real-world study of the correlation factors for complete clinical response in idiopathic inflammatory myopathies [J]. Journal of Peking University (Health Sciences), 2024, 56(2): 284-292.
[13] Xiaoqian SI,Xiujuan ZHAO,Fengxue ZHU,Tianbing WANG. Risk factors for acute respiratory distress syndrome in patients with traumatic hemorrhagic shock [J]. Journal of Peking University (Health Sciences), 2024, 56(2): 307-312.
[14] Yangyang LI,Lin HOU,Zijun MA,Shanyamei HUANG,Jie LIU,Chaomei ZENG,Jiong QIN. Association of pregnancy factors with cow's milk protein allergy in infants [J]. Journal of Peking University (Health Sciences), 2024, 56(1): 144-149.
[15] Xiaoqiang LIU,Yin ZHOU. Risk factors of perioperative hypertension in dental implant surgeries with bone augmentation [J]. Journal of Peking University (Health Sciences), 2024, 56(1): 93-98.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Copyright © Journal of Peking University (Health Sciences), All Rights Reserved.
Powered by Beijing Magtech Co. Ltd