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Factors Affecting Postoperative Spinal Epidural Hematoma and the Optimal Order of Vertebral Body Decompression in Multivertebral Microendoscopic Laminectomy

Purpose Symptomatic postoperative spinal epidural hematoma (POSEH) is a complication of spine surgery that occurs infrequently but may cause ongoing serious neurological damage. Due to the narrow entry portal, the risk of hematoma is increased after microendoscopic laminectomy (MEL) compared with co...

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Autores principales: Soejima, Yu, Arizono, Takeshi, Bekki, Hirofumi, Inokuchi, Akihiko, Izumi, Teiyu, Imamura, Ryuta, Hamada, Takahiro, Nakamura, Kimitaka, Sakai, Mamiko, Yoshimoto, Masakazu, Yamamoto, Masatoshi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9239321/
https://www.ncbi.nlm.nih.gov/pubmed/35774642
http://dx.doi.org/10.7759/cureus.25404
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author Soejima, Yu
Arizono, Takeshi
Bekki, Hirofumi
Inokuchi, Akihiko
Izumi, Teiyu
Imamura, Ryuta
Hamada, Takahiro
Nakamura, Kimitaka
Sakai, Mamiko
Yoshimoto, Masakazu
Yamamoto, Masatoshi
author_facet Soejima, Yu
Arizono, Takeshi
Bekki, Hirofumi
Inokuchi, Akihiko
Izumi, Teiyu
Imamura, Ryuta
Hamada, Takahiro
Nakamura, Kimitaka
Sakai, Mamiko
Yoshimoto, Masakazu
Yamamoto, Masatoshi
author_sort Soejima, Yu
collection PubMed
description Purpose Symptomatic postoperative spinal epidural hematoma (POSEH) is a complication of spine surgery that occurs infrequently but may cause ongoing serious neurological damage. Due to the narrow entry portal, the risk of hematoma is increased after microendoscopic laminectomy (MEL) compared with conventional open surgery, and the risk might be even higher for multivertebral MEL (m-MEL). The purpose of this study was to clarify the factors affecting the development of POSEH after m-MEL and identify the optimal order for the decompression of vertebral bodies. Methods A total of 313 patients who underwent m-MEL from 2016 to 2020 were retrospectively assessed. The cohort comprised 238 patients who underwent two-level MEL, 67 who underwent three-level MEL, and eight who underwent four-level MEL. Symptomatic POSEH was defined as the presence of an epidural hematoma at the surgical site on MRI with symptoms such as lower extremity pain or muscle weakness. We elucidated the incidence of POSEH at each vertebral level and investigated the relationship between POSEH and possible risk factors such as clinical and operative variables. Results There were 41 patients in the POSEH group and 272 patients in the non-POSEH group. Seven patients in the POSEH group underwent reoperation. The occurrence of POSEH was related to the number of decompressed vertebral bodies. Patients who underwent L2/3 and L3/4 decompression at the end of the procedure also showed a higher incidence of POSEH at the surgical level. Conclusion In patients undergoing m-MEL, treatment of the upper lumbar vertebrae at the end of decompression surgery might be a risk factor for symptomatic POSEH. The incidence of POSEH was particularly increased at L2/3, suggesting that L2/3 decompression should not be performed at last and that careful hemostasis should be applied.
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spelling pubmed-92393212022-06-29 Factors Affecting Postoperative Spinal Epidural Hematoma and the Optimal Order of Vertebral Body Decompression in Multivertebral Microendoscopic Laminectomy Soejima, Yu Arizono, Takeshi Bekki, Hirofumi Inokuchi, Akihiko Izumi, Teiyu Imamura, Ryuta Hamada, Takahiro Nakamura, Kimitaka Sakai, Mamiko Yoshimoto, Masakazu Yamamoto, Masatoshi Cureus Orthopedics Purpose Symptomatic postoperative spinal epidural hematoma (POSEH) is a complication of spine surgery that occurs infrequently but may cause ongoing serious neurological damage. Due to the narrow entry portal, the risk of hematoma is increased after microendoscopic laminectomy (MEL) compared with conventional open surgery, and the risk might be even higher for multivertebral MEL (m-MEL). The purpose of this study was to clarify the factors affecting the development of POSEH after m-MEL and identify the optimal order for the decompression of vertebral bodies. Methods A total of 313 patients who underwent m-MEL from 2016 to 2020 were retrospectively assessed. The cohort comprised 238 patients who underwent two-level MEL, 67 who underwent three-level MEL, and eight who underwent four-level MEL. Symptomatic POSEH was defined as the presence of an epidural hematoma at the surgical site on MRI with symptoms such as lower extremity pain or muscle weakness. We elucidated the incidence of POSEH at each vertebral level and investigated the relationship between POSEH and possible risk factors such as clinical and operative variables. Results There were 41 patients in the POSEH group and 272 patients in the non-POSEH group. Seven patients in the POSEH group underwent reoperation. The occurrence of POSEH was related to the number of decompressed vertebral bodies. Patients who underwent L2/3 and L3/4 decompression at the end of the procedure also showed a higher incidence of POSEH at the surgical level. Conclusion In patients undergoing m-MEL, treatment of the upper lumbar vertebrae at the end of decompression surgery might be a risk factor for symptomatic POSEH. The incidence of POSEH was particularly increased at L2/3, suggesting that L2/3 decompression should not be performed at last and that careful hemostasis should be applied. Cureus 2022-05-27 /pmc/articles/PMC9239321/ /pubmed/35774642 http://dx.doi.org/10.7759/cureus.25404 Text en Copyright © 2022, Soejima et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Orthopedics
Soejima, Yu
Arizono, Takeshi
Bekki, Hirofumi
Inokuchi, Akihiko
Izumi, Teiyu
Imamura, Ryuta
Hamada, Takahiro
Nakamura, Kimitaka
Sakai, Mamiko
Yoshimoto, Masakazu
Yamamoto, Masatoshi
Factors Affecting Postoperative Spinal Epidural Hematoma and the Optimal Order of Vertebral Body Decompression in Multivertebral Microendoscopic Laminectomy
title Factors Affecting Postoperative Spinal Epidural Hematoma and the Optimal Order of Vertebral Body Decompression in Multivertebral Microendoscopic Laminectomy
title_full Factors Affecting Postoperative Spinal Epidural Hematoma and the Optimal Order of Vertebral Body Decompression in Multivertebral Microendoscopic Laminectomy
title_fullStr Factors Affecting Postoperative Spinal Epidural Hematoma and the Optimal Order of Vertebral Body Decompression in Multivertebral Microendoscopic Laminectomy
title_full_unstemmed Factors Affecting Postoperative Spinal Epidural Hematoma and the Optimal Order of Vertebral Body Decompression in Multivertebral Microendoscopic Laminectomy
title_short Factors Affecting Postoperative Spinal Epidural Hematoma and the Optimal Order of Vertebral Body Decompression in Multivertebral Microendoscopic Laminectomy
title_sort factors affecting postoperative spinal epidural hematoma and the optimal order of vertebral body decompression in multivertebral microendoscopic laminectomy
topic Orthopedics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9239321/
https://www.ncbi.nlm.nih.gov/pubmed/35774642
http://dx.doi.org/10.7759/cureus.25404
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