Epidural hematoma following cervical Spine surgery

Gregory D. Schroeder, Alan S. Hilibrand, Paul M. Arnold, David E. Fish, Jeffrey C. Wang, Jeffrey L. Gum, Zachary A. Smith, Wellington K. Hsu, Ziya L. Gokaslan, Robert E. Isaacs, Adam S. Kanter, Thomas E. Mroz, Ahmad Nassr, Rick C. Sasso, Michael G. Fehlings, Zorica Buser, Mohamad Bydon, Peter I. Cha, Dhananjay Chatterjee, Erica L. GeeElizabeth L. Lord, Erik N. Mayer, Owen J. McBride, Emily C. Nguyen, Allison K. Roe, P. Justin Tortolani, D. Alex Stroh, Marisa Y. Yanez, K. Daniel Riew

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Study Design: A multicentered retrospective case series. Objective: To determine the incidence and circumstances surrounding the development of a symptomatic postoperative epidural hematoma in the cervical spine. Methods: Patients who underwent cervical spine surgery between January 1, 2005, and December 31, 2011, at 23 institutions were reviewed, and all patients who developed an epidural hematoma were identified. Results: A total of 16 582 cervical spine surgeries were identified, and 15 patients developed a postoperative epidural hematoma, for a total incidence of 0.090%. Substantial variation between institutions was noted, with 11 sites reporting no epidural hematomas, and 1 site reporting an incidence of 0.76%. All patients initially presented with a neurologic deficit. Nine patients had complete resolution of the neurologic deficit after hematoma evacuation; however 2 of the 3 patients (66%) who had a delay in the diagnosis of the epidural hematoma had residual neurologic deficits compared to only 4 of the 12 patients (33%) who had no delay in the diagnosis or treatment (P =.53). Additionally, the patients who experienced a postoperative epidural hematoma did not experience any significant improvement in health-related quality-of-life metrics as a result of the index procedure at final follow-up evaluation. Conclusion: This is the largest series to date to analyze the incidence of an epidural hematoma following cervical spine surgery, and this study suggest that an epidural hematoma occurs in approximately 1 out of 1000 cervical spine surgeries. Prompt diagnosis and treatment may improve the chance of making a complete neurologic recovery, but patients who develop this complication do not show improvements in the health-related quality-of-life measurements.

Original languageEnglish (US)
Pages (from-to)120S-126S
JournalGlobal Spine Journal
Volume7
Issue number1_suppl
DOIs
StatePublished - Apr 1 2017

Fingerprint

Hematoma
Spine
Neurologic Manifestations
Incidence
Quality of Life
Nervous System
Therapeutics

Keywords

  • ACDF
  • anterior cervical discectomy and fusion
  • cervical spine surgery
  • complications
  • epidural hematoma
  • posterior cervical
  • postoperative epidural hematoma

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Schroeder, G. D., Hilibrand, A. S., Arnold, P. M., Fish, D. E., Wang, J. C., Gum, J. L., ... Riew, K. D. (2017). Epidural hematoma following cervical Spine surgery. Global Spine Journal, 7(1_suppl), 120S-126S. https://doi.org/10.1177/2192568216687754

Epidural hematoma following cervical Spine surgery. / Schroeder, Gregory D.; Hilibrand, Alan S.; Arnold, Paul M.; Fish, David E.; Wang, Jeffrey C.; Gum, Jeffrey L.; Smith, Zachary A.; Hsu, Wellington K.; Gokaslan, Ziya L.; Isaacs, Robert E.; Kanter, Adam S.; Mroz, Thomas E.; Nassr, Ahmad; Sasso, Rick C.; Fehlings, Michael G.; Buser, Zorica; Bydon, Mohamad; Cha, Peter I.; Chatterjee, Dhananjay; Gee, Erica L.; Lord, Elizabeth L.; Mayer, Erik N.; McBride, Owen J.; Nguyen, Emily C.; Roe, Allison K.; Tortolani, P. Justin; Stroh, D. Alex; Yanez, Marisa Y.; Riew, K. Daniel.

In: Global Spine Journal, Vol. 7, No. 1_suppl, 01.04.2017, p. 120S-126S.

Research output: Contribution to journalArticle

Schroeder, GD, Hilibrand, AS, Arnold, PM, Fish, DE, Wang, JC, Gum, JL, Smith, ZA, Hsu, WK, Gokaslan, ZL, Isaacs, RE, Kanter, AS, Mroz, TE, Nassr, A, Sasso, RC, Fehlings, MG, Buser, Z, Bydon, M, Cha, PI, Chatterjee, D, Gee, EL, Lord, EL, Mayer, EN, McBride, OJ, Nguyen, EC, Roe, AK, Tortolani, PJ, Stroh, DA, Yanez, MY & Riew, KD 2017, 'Epidural hematoma following cervical Spine surgery', Global Spine Journal, vol. 7, no. 1_suppl, pp. 120S-126S. https://doi.org/10.1177/2192568216687754
Schroeder GD, Hilibrand AS, Arnold PM, Fish DE, Wang JC, Gum JL et al. Epidural hematoma following cervical Spine surgery. Global Spine Journal. 2017 Apr 1;7(1_suppl):120S-126S. https://doi.org/10.1177/2192568216687754
Schroeder, Gregory D. ; Hilibrand, Alan S. ; Arnold, Paul M. ; Fish, David E. ; Wang, Jeffrey C. ; Gum, Jeffrey L. ; Smith, Zachary A. ; Hsu, Wellington K. ; Gokaslan, Ziya L. ; Isaacs, Robert E. ; Kanter, Adam S. ; Mroz, Thomas E. ; Nassr, Ahmad ; Sasso, Rick C. ; Fehlings, Michael G. ; Buser, Zorica ; Bydon, Mohamad ; Cha, Peter I. ; Chatterjee, Dhananjay ; Gee, Erica L. ; Lord, Elizabeth L. ; Mayer, Erik N. ; McBride, Owen J. ; Nguyen, Emily C. ; Roe, Allison K. ; Tortolani, P. Justin ; Stroh, D. Alex ; Yanez, Marisa Y. ; Riew, K. Daniel. / Epidural hematoma following cervical Spine surgery. In: Global Spine Journal. 2017 ; Vol. 7, No. 1_suppl. pp. 120S-126S.
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abstract = "Study Design: A multicentered retrospective case series. Objective: To determine the incidence and circumstances surrounding the development of a symptomatic postoperative epidural hematoma in the cervical spine. Methods: Patients who underwent cervical spine surgery between January 1, 2005, and December 31, 2011, at 23 institutions were reviewed, and all patients who developed an epidural hematoma were identified. Results: A total of 16 582 cervical spine surgeries were identified, and 15 patients developed a postoperative epidural hematoma, for a total incidence of 0.090{\%}. Substantial variation between institutions was noted, with 11 sites reporting no epidural hematomas, and 1 site reporting an incidence of 0.76{\%}. All patients initially presented with a neurologic deficit. Nine patients had complete resolution of the neurologic deficit after hematoma evacuation; however 2 of the 3 patients (66{\%}) who had a delay in the diagnosis of the epidural hematoma had residual neurologic deficits compared to only 4 of the 12 patients (33{\%}) who had no delay in the diagnosis or treatment (P =.53). Additionally, the patients who experienced a postoperative epidural hematoma did not experience any significant improvement in health-related quality-of-life metrics as a result of the index procedure at final follow-up evaluation. Conclusion: This is the largest series to date to analyze the incidence of an epidural hematoma following cervical spine surgery, and this study suggest that an epidural hematoma occurs in approximately 1 out of 1000 cervical spine surgeries. Prompt diagnosis and treatment may improve the chance of making a complete neurologic recovery, but patients who develop this complication do not show improvements in the health-related quality-of-life measurements.",
keywords = "ACDF, anterior cervical discectomy and fusion, cervical spine surgery, complications, epidural hematoma, posterior cervical, postoperative epidural hematoma",
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AU - Hilibrand, Alan S.

AU - Arnold, Paul M.

AU - Fish, David E.

AU - Wang, Jeffrey C.

AU - Gum, Jeffrey L.

AU - Smith, Zachary A.

AU - Hsu, Wellington K.

AU - Gokaslan, Ziya L.

AU - Isaacs, Robert E.

AU - Kanter, Adam S.

AU - Mroz, Thomas E.

AU - Nassr, Ahmad

AU - Sasso, Rick C.

AU - Fehlings, Michael G.

AU - Buser, Zorica

AU - Bydon, Mohamad

AU - Cha, Peter I.

AU - Chatterjee, Dhananjay

AU - Gee, Erica L.

AU - Lord, Elizabeth L.

AU - Mayer, Erik N.

AU - McBride, Owen J.

AU - Nguyen, Emily C.

AU - Roe, Allison K.

AU - Tortolani, P. Justin

AU - Stroh, D. Alex

AU - Yanez, Marisa Y.

AU - Riew, K. Daniel

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N2 - Study Design: A multicentered retrospective case series. Objective: To determine the incidence and circumstances surrounding the development of a symptomatic postoperative epidural hematoma in the cervical spine. Methods: Patients who underwent cervical spine surgery between January 1, 2005, and December 31, 2011, at 23 institutions were reviewed, and all patients who developed an epidural hematoma were identified. Results: A total of 16 582 cervical spine surgeries were identified, and 15 patients developed a postoperative epidural hematoma, for a total incidence of 0.090%. Substantial variation between institutions was noted, with 11 sites reporting no epidural hematomas, and 1 site reporting an incidence of 0.76%. All patients initially presented with a neurologic deficit. Nine patients had complete resolution of the neurologic deficit after hematoma evacuation; however 2 of the 3 patients (66%) who had a delay in the diagnosis of the epidural hematoma had residual neurologic deficits compared to only 4 of the 12 patients (33%) who had no delay in the diagnosis or treatment (P =.53). Additionally, the patients who experienced a postoperative epidural hematoma did not experience any significant improvement in health-related quality-of-life metrics as a result of the index procedure at final follow-up evaluation. Conclusion: This is the largest series to date to analyze the incidence of an epidural hematoma following cervical spine surgery, and this study suggest that an epidural hematoma occurs in approximately 1 out of 1000 cervical spine surgeries. Prompt diagnosis and treatment may improve the chance of making a complete neurologic recovery, but patients who develop this complication do not show improvements in the health-related quality-of-life measurements.

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KW - anterior cervical discectomy and fusion

KW - cervical spine surgery

KW - complications

KW - epidural hematoma

KW - posterior cervical

KW - postoperative epidural hematoma

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