Soejima Yu, Arizono Takeshi, Bekki Hirofumi, Inokuchi Akihiko, Izumi Teiyu, Imamura Ryuta, Hamada Takahiro, Nakamura Kimitaka, Sakai Mamiko, Yoshimoto Masakazu, Yamamoto Masatoshi
Department of Orthopedic Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, JPN.
Department of Orthopedic Surgery, National Hospital Organization Kyushu Medical Center, Fukuoka, JPN.
Cureus. 2022 May 27;14(5):e25404. doi: 10.7759/cureus.25404. eCollection 2022 May.
Purpose Symptomatic postoperative spinal epidural hematoma (POSEH) is a complication of spine surgery that occurs infrequently but may cause ongoing serious neurological damage. Due to the narrow entry portal, the risk of hematoma is increased after microendoscopic laminectomy (MEL) compared with conventional open surgery, and the risk might be even higher for multivertebral MEL (m-MEL). The purpose of this study was to clarify the factors affecting the development of POSEH after m-MEL and identify the optimal order for the decompression of vertebral bodies. Methods A total of 313 patients who underwent m-MEL from 2016 to 2020 were retrospectively assessed. The cohort comprised 238 patients who underwent two-level MEL, 67 who underwent three-level MEL, and eight who underwent four-level MEL. Symptomatic POSEH was defined as the presence of an epidural hematoma at the surgical site on MRI with symptoms such as lower extremity pain or muscle weakness. We elucidated the incidence of POSEH at each vertebral level and investigated the relationship between POSEH and possible risk factors such as clinical and operative variables. Results There were 41 patients in the POSEH group and 272 patients in the non-POSEH group. Seven patients in the POSEH group underwent reoperation. The occurrence of POSEH was related to the number of decompressed vertebral bodies. Patients who underwent L2/3 and L3/4 decompression at the end of the procedure also showed a higher incidence of POSEH at the surgical level. Conclusion In patients undergoing m-MEL, treatment of the upper lumbar vertebrae at the end of decompression surgery might be a risk factor for symptomatic POSEH. The incidence of POSEH was particularly increased at L2/3, suggesting that L2/3 decompression should not be performed at last and that careful hemostasis should be applied.
目的 症状性术后脊柱硬膜外血肿（POSEH）是脊柱手术的一种并发症，虽不常见，但可能导致持续性严重神经损伤。由于手术入路狭窄，与传统开放手术相比，显微内镜下椎板切除术（MEL）后血肿风险增加，而多节段MEL（m-MEL）的风险可能更高。本研究的目的是阐明影响m-MEL后POSEH发生的因素，并确定椎体减压的最佳顺序。方法 回顾性评估2016年至2020年期间接受m-MEL的313例患者。该队列包括238例行两节段MEL的患者、67例行三节段MEL的患者和8例行四节段MEL的患者。症状性POSEH定义为MRI显示手术部位硬膜外血肿且伴有下肢疼痛或肌肉无力等症状。我们阐明了每个椎体节段POSEH的发生率，并调查了POSEH与临床和手术变量等可能危险因素之间的关系。结果 POSEH组有41例患者，非POSEH组有272例患者。POSEH组有7例患者接受了再次手术。POSEH的发生与减压椎体的数量有关。在手术结束时进行L2/3和L3/4减压的患者在手术节段的POSEH发生率也较高。结论 在接受m-MEL的患者中，减压手术结束时处理上腰椎椎体可能是症状性POSEH的一个危险因素。POSEH的发生率在L2/3节段尤其增加，这表明不应最后进行L2/3减压，应仔细止血。
