title: Incidence of postoperative symptomatic epidural hematoma in spinal decompression surgery.
abstract: OBJECTIVE
  Neurological deterioration due to spinal epidural hematoma (SEH) is a rare but significant complication of spinal surgery. The frequency of hematoma evacuation after spinal surgery is reportedly 0.1%-3%. The objective of this study was to investigate the symptomatology of SEH and the frequency of evacuation for each surgical procedure after spinal decompression surgery.
  
  
  METHODS
  This is a retrospective study of 26 patients who underwent SEH evacuation after spinal decompression surgery between 1986 and 2005. During this period, 6356 spinal decompression surgeries were performed. The factors studied were the frequency of SEH evacuation for each surgical procedure, symptoms, time to SEH evacuation, comorbidities, and neurological recovery.
  
  
  RESULTS
  The frequency of SEH evacuation was 0.41% (26 of 6356) for all operations. The frequency for each surgical procedure was 0% (0 of 1568) in standard lumbar discectomy, 0.50% (8 of 1614) in lumbar laminectomy, 0.67% (8 of 1191) in posterior lumbar interbody fusion, 4.46% (5 of 112) in thoracic laminectomy, 0.44% (4 of 910) in cervical laminoplasty, and 0.21% (1 of 466) in cervical anterior spinal fusion. Nine patients had comorbidities involving hemorrhage. Spinal epidural hematoma evacuation was performed between 4 hours and 8 days after the initial operation. Whereas severe paralysis was observed within 24 hours in most patients undergoing cervical and/or thoracic surgery, half of the patients undergoing lumbar surgery had symptoms of SEH such as leg pain or bladder dysfunction after suction drain removal. The shorter the period to evacuation, the better were the results of neurological recovery.
  
  
  CONCLUSIONS
  Postoperative SEH was most frequent after thoracic laminectomy. In cervical and thoracic surgeries, symptoms of SEH were noted within 24 hours, mostly severe paralysis, and almost half of the lumbar surgery patients had symptoms after suction drain removal.
authors.affiliation: Department of Orthopaedic Surgery, Osaka National Hospital, Chuoku, Osaka, Japan. h-aono@umin.ac.jp
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Aono
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ohwada
authors.forename: Noboru
authors.initials: N
authors.lastname: Hosono
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Tobimatsu
authors.forename: Kenta
authors.initials: K
authors.lastname: Ariga
authors.forename: Takeshi
authors.initials: T
authors.lastname: Fuji
authors.forename: Motoki
authors.initials: M
authors.lastname: Iwasaki
mesh_terms: D000328:Adult; D015897:Comorbidity; D019299:Decompression, Surgical / Q000009:adverse effects*; D046748:Hematoma, Epidural, Spinal / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D006801:Humans; D015994:Incidence; D007796:Laminectomy / Q000009:adverse effects*; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects*; D013131:Spine / Q000601:surgery*; D016896:Treatment Outcome