Akut postoperatif servikal epidural hematom

Öz

Amaç: Bu çalışmanın amacı semptomatik akut postoperatif servikal epidural hematomun (APSEH) klinik sunumu, nedenleri ve risk faktörleri ile tedavisi ve tedavi sonuçlarını değerlendirmek idi.

Çalışma planı: Çalışmada 1 Ocak 2004 ile 31 Ekim 2008 tarihleri arasında servikal omurga cerrahisi uygulanan hastaların tümü retrospektif olarak gözden geçirildi. Koagülasyon parametreleri, hastanın tıbbi geçmişi, yaş, cinsiyet, dekompresyona dek geçen zaman, dekompresyon cerrahisi öncesi ve sonrası hastanın nörolojik durumu, hematom oluşumunun süresi ve segmentlerin bulunduğu seviyeler incelendi. Dura dışında gelişebilecek hematom için potansiyel risk faktörleri hesaplandı. Akut postoperatif servikal epidural hematom tanısı alan hastalar acil drenaj cerrahisine alındı.

Bulgular: Ortopedik Omurga Rahatsızlıkları Grubu tarafından hastanemizde 2004 ve 2008 yılları arasında 2,338’in üzerinde servikal omurga cerrahisi gerçekleştirilmiştir. Bunlardan 12’sine (%0.5) APSEH tanısı konuldu. Hastaların üçte ikisinde hipertansif hastalık öyküsü veya geçici hipertansiyon söz konusuydu. Hastaların hiçbirinde cerrahi öncesi anormal koagülasyon parametresi ve kanama diyatezi yoktu veya cerrahi sırasında koagülopati gelişmemişti. Nihai kesin hematom tanısı konulmasından sonraki 2 saat içinde hastaların hematomlarının boşaltımı gerçekleştirildi.

Çıkarımlar: Akut postoperatif servikal epidural hematom postoperatif dönemde nörolojik durumun kötüleşmesine yol açan ender komplikasyonlardandır. Hipertansiyonlu hastalarda çok seviyeli spinal cerrahi sonrası hematom riskinin yüksek olduğu bilinmektedir. Hematomun erken tanısı ve boşaltımı nörolojik hasarın giderilmesine olanak sağlamaktadır.

Anahtar Kelimeler

• Servikal omurga cerrahisi; spinal epidural hematom; tedavi

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.

Conclusion: 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.

Keywords

• Cervical spinal surgery
• risk factor
• spinal epidural hematoma
• treatment

References

1. Jackson R. Case of spinal apoplexy. Lancet 1869;2:5-6.
2. Uribe J, Moza K, Jimenez O, Green B, Levi AD. De- layed postoperative spinal epidural hematomas. Spine J 2003;3:125-9.
3. Ikuta K, Tono O, Tanaka T, Arima J, Nakano S, Sasaki K, et al. Evaluation of postoperative spinal epidural hema- toma after microendoscopic posterior decompression for lumbar spinal stenosis: a clinical and magnetic resonance imaging study. J Neurosurg Spine 2006;5:404-9.
4. Swamy G, Tay B, Walker JC, Hu S, Berven S, Ames C, et al. Postoperative spinal epidural hematoma – management and neurological outcome. Proceedings of the NASS 20th annual meeting. The Spine Journal 2005;5:1-189.
5. Lawton MT, Porter RW, Heiserman JE, Jacobowitz R, Sonntag VK, Dickman CA. Surgical management of spi- nal epidural hematoma: relationship between surgical tim- ing and neurological outcome. J Neurosurg 1995;83:1-7.
6. Scavarda D, Peruzzi P, Bazin A, Scherpereel B, Gomis P, Graftieaux JP, et al. Postoperative spinal extradural he- matomas. 14 cases. [Article in French] Neurochirurgie 1997;43:220-7. [Abstract]
7. Frankel HL, Hancock DO, Hyslop G, Melzak J, Michaelis LS, Ungar GH, et al. The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. I. Paraplegia 1969;7:179-92.
8. Awad JN, Kebaish KM, Donigan J, Cohen D, Kostuik JP. An analysis of risk factors and incidence of postsurgical spinal epidural hematoma. Proceedings of the NASS 18th annual meeting. The Spine Journal 2003;3:67-171.

9. Groen RJ, Ponssen H. The spontaneous spinal epi- dural hematoma. A study of the etiology. J Neurol Sci 1990;98:121-38.
10. Hentschel SJ, Woolfenden AR, Fairholm DJ. Resolution of spontaneous spinal epidural hematoma without sur- gery: report of two cases. Spine 2001;26:E525-7.
11. Patel H, Boaz JC, Phillips JP, Garg BP. Spontaneous spinal epidural hematoma in children. Pediatr Neurol 1998;19:302-7.
12. Henderson RD, Pittock SJ, Piepgras DG, Wijdicks EF. Acute spontaneous spinal epidural hematoma. Arch Neu- rol 2001;58:1145-6.
13. Cullen DJ, Bogdanov E, Htut N. Spinal epidural hema- toma occurrence in the absence of known risk factors: a case series. J Clin Anesth 2004;16:376-81.
14. Sokolowski MJ, Garvey TA, Perl J 2nd, Sokolowski MS, Cho W, Mehbod AA, et al. Prospective study of postop- erative lumbar epidural hematoma: incidence and risk fac- tors. Spine (Phila Pa 1976) 2008;33:108-13.
15. Gelabert M, Iglesias M, González J, Fernández J. Sponta- neous spinal epidural hematomas: review of 8 cases. [Ar- ticle in Spanish] Neurologia 2003;18:357-63. [Abstract]
16. Kebaish K, Matteri R, Campbell J. Correlation between neurological recovery and timing of surgical decompres- sion of postoperative spinal epidural hematoma. Proceed- ings of the NASS 21st annual meeting. The Spine Journal 2006;6:1-161.
17. Groen RJ, van Alphen HA. Operative treatment of spon- taneous spinal epidural hematomas: a study of the fac- tors determining postoperative outcome. Neurosurgery 1996;39:494-509.
18. Liao CC, Lee ST, Hsu WC, Chen LR, Lui TN, Lee SC. Experience in the surgical management of spontaneous spinal epidural hematoma. J Neurosurg 2004;100(1 Sup- pl Spine):38-45.