Shin Hun-Kyu, Jeong Hwa-Jae, Kim Eugene, Park Jai Hyung, Park Se-Jin, Cho Yongun
Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Clin Orthop Surg. 2017 Jun;9(2):184-189. doi: 10.4055/cios.2017.9.2.184. Epub 2017 May 8.
A postoperative magnetic resonance imaging (MRI) is performed as a routine to assess decompression of the spinal cord as well as to evaluate postoperative complications. The purpose of this study is to analyze the efficacy of postoperative MRI for hematoma in spinal decompression surgery.
Between January 1, 2008 and January 31, 2015, 185 patients who underwent postoperative MRI after spinal decompression surgery were included in this study. We checked the history of the use of an anticoagulant or antiplatelet agent, withdrawal period, blood platelet count, and prothrombin time (international normalized ratio [INR]). We measured the total amount of suction drainage and duration until removal. We retrospectively reviewed the presence of hematoma and thecal sac compression. Postoperative prognosis was evaluated by a visual analog scale (VAS) and the Oswestry Disability Index (ODI).
Hematomas were found on postoperative MRI scans in 97 out of 185 patients (52.4%). Thirty patients had a thecal sac compressing hematoma: 7 in the cervical spine, 1 in the thoracic spine, and 22 in the lumbar spine. The occurrence of hematoma did not show significant difference according to the use of an anticoagulant ( = 0.157). The blood platelet count, prothrombin time (INR), and suction drainage duration did not have a statistically significant correlation with the occurrence of hematoma ( = 0.562, = 0.506, and = 0.429, respectively). The total amount of suction drainage was significantly different according to the presence of hematoma ( = 0.022). The total 185 patients had a significant decrease in the postoperative VAS score ( < 0.001), and the diminution of VAS score was not significantly different according to the occurrence of hematoma ( = 0.243). Even in the cases of thecal sac compressing hematoma, the reduction of VAS score was not significantly different ( = 0.689).
Postoperative MRI for hematoma in spinal decompression surgery has little effect on prognosis or management. Therefore, indiscriminate postoperative MRI should be avoided and MRI should be performed depending on the patient's status.
术后磁共振成像（MRI）作为一项常规检查用于评估脊髓减压情况以及术后并发症。本研究的目的是分析术后MRI在脊柱减压手术中对血肿的评估效果。
2008年1月1日至2015年1月31日期间，185例接受脊柱减压手术后进行MRI检查的患者纳入本研究。我们检查了抗凝剂或抗血小板药物的使用史、停药期、血小板计数和凝血酶原时间（国际标准化比值[INR]）。我们测量了吸引引流总量及直至拔除引流管的持续时间。我们回顾性分析了血肿的存在情况及硬脊膜囊受压情况。通过视觉模拟评分法（VAS）和Oswestry功能障碍指数（ODI）评估术后预后。
185例患者中，97例（52.4%）术后MRI扫描发现有血肿。30例患者存在硬脊膜囊受压血肿：颈椎7例，胸椎1例，腰椎22例。根据抗凝剂的使用情况，血肿的发生率无显著差异（P = 0.157）。血小板计数、凝血酶原时间（INR）和吸引引流持续时间与血肿的发生无统计学显著相关性（分别为P = 0.562、P = 0.506和P = 0.429）。根据血肿的存在情况，吸引引流总量有显著差异（P = 0.022）。185例患者术后VAS评分显著降低（P < 0.001），根据血肿的发生情况，VAS评分的降低无显著差异（P = 0.243）。即使是硬脊膜囊受压血肿的病例，VAS评分的降低也无显著差异（P = 0.689）。
脊柱减压手术中用于评估血肿的术后MRI对预后或治疗的影响很小。因此，应避免不加选择地进行术后MRI检查，而应根据患者情况进行MRI检查。
