Goldstein Christina L, Bains Ish, Hurlbert R John
Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary Spine Program, Foothills Medical Centre, 12th Floor, Room 1250, 1403 29th St NW, Calgary, Alberta T2N 2T9, Canada.
Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary Spine Program, Foothills Medical Centre, 12th Floor, Room 1250, 1403 29th St NW, Calgary, Alberta T2N 2T9, Canada.
Spine J. 2015 Jun 1;15(6):1179-87. doi: 10.1016/j.spinee.2013.11.043. Epub 2013 Dec 6.
The true incidence of symptomatic spinal epidural hematoma (SEH) after surgery of the posterior cervical spine and risk factors for its development remain unclear.
The purpose of this study was to determine the 10-year incidence of symptomatic postoperative SEH and identify risk factors for its development.
STUDY DESIGN/SETTING: This study is a retrospective observational study at a Canadian tertiary care spine center.
The study sample includes adult patients undergoing posterior surgery of the cervical spine.
The outcome measures were the incidence of symptomatic postoperative SEH and risk factors for its development.
Surgical procedure codes were used to identify study candidates. Using a standard data collection form, two independent reviewers manually searched paper and electronic medical records to extract patient-, treatment-, and complication-related data. Time to presentation, clinical findings, method of treatment, and intraoperative findings (when relevant) were recorded for patients with an SEH. The overall incidence of symptomatic SEH was calculated, and the categorical and continuous variables were summarized with percentages and means, respectively. Stepwise forward selection logistic regression analysis was performed to identify risk factors for the development of symptomatic SEH.
From January 2002 to December 2011, 529 patients (356 men and 173 women; mean age, 56.7 years) were identified for study inclusion. The mean Charlson Comorbidity Index (CCI) was 0.65 (range, 0-8). Myelopathy was the most common surgical indication (n=293; 55.4%), with the largest subset of patients undergoing decompression with or without instrumented fusion (n=266; 50.3%). Symptomatic postoperative SEH was diagnosed in eight patients for an overall incidence of 1.5%. Postoperative nonsteroidal anti-inflammatory drug (NSAID) use and an increased CCI were identified as significant predictors of the development of a symptomatic SEH in our study cohort (p=.024 and .003, respectively). When all other variables remained constant, a 1-point increase in CCI was associated with 1.6 times higher odds of hematoma development, whereas postoperative NSAID use increased the odds 6.6 times.
Symptomatic SEH may occur in up to 1.5% of patients undergoing posterior cervical spine surgery. Patients with a higher level of comorbid disease appear to be at increased risk of development of a symptomatic SEH, although avoidance of postoperative NSAIDs may decrease the risk of its development.
颈椎后路手术后症状性脊髓硬膜外血肿（SEH）的真实发病率及其发生的危险因素仍不明确。
本研究旨在确定症状性术后SEH的10年发病率，并识别其发生的危险因素。
研究设计/地点：本研究是在加拿大一家三级脊柱护理中心进行的回顾性观察研究。
研究样本包括接受颈椎后路手术的成年患者。
观察指标为症状性术后SEH的发病率及其发生的危险因素。
使用手术操作编码来确定研究对象。两名独立的研究者使用标准数据收集表，人工检索纸质和电子病历，以提取与患者、治疗和并发症相关的数据。记录SEH患者的就诊时间、临床表现、治疗方法和术中所见（如相关）。计算症状性SEH的总体发病率，分类变量和连续变量分别用百分比和均值进行总结。进行逐步向前选择逻辑回归分析，以识别症状性SEH发生的危险因素。
2002年1月至2011年12月，共纳入529例患者（男性356例，女性173例；平均年龄56.7岁）进行研究。平均查尔森合并症指数（CCI）为0.65（范围0 - 8）。脊髓病是最常见的手术指征（n = 293；55.4%），其中接受减压手术（伴或不伴器械融合）的患者子集最大（n = 266；50.3%）。8例患者被诊断为症状性术后SEH，总体发病率为1.5%。在我们的研究队列中，术后使用非甾体抗炎药（NSAID）和CCI升高被确定为症状性SEH发生的显著预测因素（分别为p = .024和.003）。当所有其他变量保持不变时，CCI每增加1分，血肿发生的几率高1.6倍，而术后使用NSAID使几率增加6.6倍。
接受颈椎后路手术的患者中，症状性SEH的发生率可能高达1.5%。合并症程度较高的患者出现症状性SEH的风险似乎增加，尽管避免术后使用NSAID可能会降低其发生风险。
