title: Acute postoperative cervical spinal epidural hematoma.
abstract: OBJECTIVE
  The aim of this study was to assess the clinical presentation, causes or risk factors, treatment and outcomes of symptomatic acute postoperative cervical spinal epidural hematoma (APCSEH).
  
  
  METHODS
  The study retrospectively reviewed all patients who underwent open cervical spinal surgery between January 1, 2004 and October 31, 2008. Perioperative coagulation parameters, past medical history, age, gender, time to decompression, pre- and postoperative (decompression operation) neurological status, as well as the interval of hematoma formation and level of segments were reviewed. Potential risk factors for extradural hematomas were examined. Patients who were diagnosed with APCSEH underwent immediate surgical drainage of the hematoma.
  
  
  RESULTS
  Over 2,338 cervical spinal surgeries were performed by the Orthopedic Spinal Disorder Group in our hospital between 2004 and 2008. Twelve (0.5%) cases of APCSEH were identified. Two-thirds of the patients had history of hypertensive disease or transitory hypertensive status after surgery. No patients had abnormal preoperative coagulation parameters, bleeding diathesis or developed intraoperative coagulopathy. All patients were treated with hematoma evacuation within 2 hours of the ultimately definitive diagnosis of hematoma.
  
  
  CONCLUSIONS
  Acute postoperative cervical spinal epidural hematoma is a rare cause of postoperative neurological deterioration. Hypertensive disease and the method of multilevel cervical surgery appear to increase bleeding and predict formation of hematoma. Early diagnosis and evacuation of the hematoma can result in resolution of the neurological deficit.
authors.affiliation: Department of Orthopedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China; Department of Orthopedic Surgery, 422 Hospital of PLA, Zhangjiang, China. ygd0810@126.com.
authors.forename: Guodong
authors.initials: G
authors.lastname: Yin
authors.affiliation: Department of Orthopedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Ni
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical; D005260:Female; D046748:Hematoma, Epidural, Spinal / Q000175:diagnosis* / Q000628:therapy*; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D006973:Hypertension / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011184:Postoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D013122:Spinal Diseases / Q000150:complications* / Q000601:surgery*; D016896:Treatment Outcome