Analysis of detailed clinical characteristics of spinal subdural hematoma following lumbar decompression surgery.

BACKGROUND: Only a few reports have described symptomatic patients with postoperative spinal subdural hematoma (SSH) for which further surgery may have been required. No report has focused on the detailed clinical characteristics of postoperative SSH, including asymptomatic cases, in a case series. The reasons for this may be that SSH is an implicitly recognized rare entity, and there is no established consensus regarding the significance of performing postoperative magnetic resonance imaging (MRI) for all cases and the time at which to perform it. In this case-controlled retrospective analysis, we attempted to identify a detailed clinical presentation of SSH after open lumbar decompression surgery using MRI taken uniformly at 14 days before hospital discharge. METHODS: We retrospectively studied 196 patients who underwent routine MRI following open lumbar spinous process-splitting decompression surgery between 2012 and 2016. We assessed the frequency, clinical presentation, and radiological findings of SSH that developed postoperatively. Furthermore, we used a multivariate analysis to identify factors that were postulated to increase the risk of SSH postoperatively. RESULTS: None of the patients developed serious neurologic deficits, such as paresis or bladder and bowel dysfunction that required emergency evacuation. However, our results showed that postoperative SSHs, including asymptomatic SSHs, developed considerably frequently (43/182 patients, 23.6%). Furthermore, of the 43 patients with SSH, three presented with new postoperative neurologic findings that were strongly suspected to be associated with SSH. Multivariate analysis identified that preoperative hypertension (adjusted odds ratio [aOR]: 2.501, P = 0.018), anticoagulant therapy (aOR: 2.716, P = 0.021), and multilevel procedures (aOR: 2.327, P = 0.034) were significant risk factors of postoperative SSH. CONCLUSIONS: Spine surgeons should be aware that postoperative SSH is not rare and is a potential cause of recurrent pain or neurologic deterioration perioperatively.

Predictors of Outcome in Nontraumatic Spontaneous Acute Spinal Subdural Hematoma: Case Report and Literature Review.

OBJECTIVES: To analyze the clinical presentation and outcome of nontraumatic spontaneous acute spinal subdural hematoma by observing the predictors of outcome. METHODS/RESULTS: This study was based on a case report and systematic review of the international literature. Among the 151 patients, 80 were female and 65 were male (1.25 female/1.0 male). The age distribution ranged from 6 months to 87 years, with a small increase in incidence between the first and second decade of life and a major peak at age 60 years. The difference of proportion of good results between patients with and without established neurologic deficits was: 0.488, 95% confidence interval (95% CI) 0.237-0.648, P = 2.71e-08; coagulopathy was 0.335, 95% CI 0.163-0.508, P = 0.0002; SAH was 0.0539, 95% CI -0.119 to 0.226, P = 0.6529; lumbar puncture/associated diseases was 0.149 95% CI -0.032 to 0.330, P = 0.1171; surgery was 0.0593, 95% CI -0.114 to 0.233, P = 0.5838; and hematoma extension equal or longer than 5 levels was 0.010 95% CI -0.178 to 0.197, P = 1. CONCLUSIONS: Although mortality and morbidity associated with nontraumatic spontaneous acute spinal subdural hematoma has decreased during the last 2 decades, the disease still carries a mortality rate of approximately1.3% and a morbidity (permanent neurologic deficits) rate of 28%. The main factors affecting the outcome are neurologic status at presentation and coagulopathies.

Acute spinal subdural hematoma in a patient with active systemic lupus erythematosus: a case report and literature review.

We herein describe a case of acute spinal subdural hematoma (SSDH) during the administration of high-dose corticosteroids and intravenous heparin for the treatment of active lupus nephritis. After SSDH was promptly diagnosed using magnetic resonance imaging (MRI), the patient recovered well with conservative treatment involving the discontinuation of heparin sodium. Although SSDH is a rare complication, it should be considered as a cause of neurological manifestations in patients with active systemic lupus erythematosus.

[Incidence in Catalonia of spinal cord compression due to spinal hematoma secondary to neuraxial anesthesia]. / Incidencia de hematomas espinales con compresión medular relacionados con anestesias neuroaxiales en Cataluña.

OBJECTIVE: To study the incidence in Catalonia of spinal cord compression due to spinal hematoma secondary to neuraxial anesthesia. METHODS: The incidence of hematoma was based on published cases (MEDLINE, the Spanish Medical Index [Indice Medico Español], and Google) or cases reported at medical meetings or conferences by anesthesiologists from Catalan hospitals from 1996 to 2005, inclusive. The annual number of neuraxial anesthesias (spinal, epidural, and combined) was estimated based on the ANESCAT 2003 survey and the total number of anesthesias was calculated using the ANESCAT 2003 survey in conjunction with the surgical reports of Catalan hospitals. RESULTS: A total of 11 cases of spinal hematoma after neuraxial anesthesia (7 after spinal anesthesia and 4 after epidural anesthesia) were reported or published from 1996 to 2005, inclusive. A total of 194 154 neuraxial anesthesias were performed in 2003 (126 560 spinal anesthesias and 5926 combined spinal-epidural anesthesias) and it was estimated that somewhat over 1 700 000 neuraxial anesthesias were performed over the 10 years reviewed. The incidence (95% confidence interval [CI]) of hematoma was 0.6 (95% CI, 0.3-1.2) per 100 000 neuraxial anesthesias, 0.6 (95% CI, 0.3-1.3) per 100 000 spinal anesthesias, and 0.7 (95% CI, 0.2-1.9) per 100 000 epidural anesthesias. CONCLUSIONS: The incidence of spinal hematoma after neuraxial anesthesia is slightly more than 1 per 150 000 anesthesias-a similar finding to that of other epidemiological studies. The incidence is slightly higher in epidural anesthesia. These data imply a risk of approximately 1 spinal hematoma per year in Catalonia.