Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea.
Clin Orthop Surg. 2023 Apr;15(2):265-271. doi: 10.4055/cios22297. Epub 2023 Mar 15.
The most common cause of neurological complications after a biportal endoscopic spine surgery (BESS) is postoperative spinal epidural hematomas (POSEH). The objective of this study was to determine the influence of systolic blood pressure at extubation (e-SBP) on POSEH.
A total of 352 patients who underwent single-level decompression surgery including laminectomy and/or discectomy with BESS under the diagnosis of spinal stenosis and herniated nucleus pulposus between August 1, 2018, and June 30, 2021, were reviewed retrospectively. The patients were divided into two, a POSEH group and a normal group without POSEH (no neurological complication). The e-SBP, demographic factors, and the preoperative and intraoperative factors suspected to influence the POSEH were analyzed. The e-SBP was converted to a categorical variable by the threshold level that was decided by maximum area under the curve (AUC) in receiver operating characteristic (ROC) curve analysis. Antiplatelet drugs (APDs) were taken in 21 patients (6.0%), discontinued in 24 patients (6.8%), and not taken in 307 patients (87.2%). Tranexamic acid (TXA) was used in 292 patients (83.0%) in the perioperative period.
Of the 352 patients, 18 patients (5.1%) underwent revision surgery for the removal of POSEH. The POSEH and normal groups were homogenous in age, sex, diagnosis, operation segments, operation time, and lab findings that were related to blood clotting, whereas there were differences in e-SBP (163.7 ± 15.7 mmHg in POSEH group and 154.1 ± 18.3 mmHg in normal group), APD (4 takers, 2 stoppers, 12 non-takers in POSEH group and 16 takers, 22 stoppers, 296 non-takers in normal group), and TXA (12 use, 6 not use in POSEH group and 280 use, 54 not use in normal group) in single variable analysis. The highest AUC in the ROC curve analysis was 0.652 for 170 mmHg e-SBP ( < 0.05). There were 94 patients in the high e-SBP group (≥ 170 mmHg) and 258 patients in the low e-SBP group. In multivariable logistic regression analysis, only high e-SBP was a significant risk factor for POSEH ( = 0.013; odds ratio, 3.434).
High e-SBP (≥ 170 mmHg) can influence the development of POSEH in biportal endoscopic spine surgery.
经双通道内镜脊柱手术（BESS）后发生神经并发症的最常见原因是术后硬脊膜外血肿（POSEH）。本研究旨在确定拔管时收缩压（e-SBP）对 POSEH 的影响。
回顾性分析 2018 年 8 月 1 日至 2021 年 6 月 30 日期间，因椎管狭窄和椎间盘突出症行单节段减压手术（包括椎板切除术和/或椎间盘切除术）并接受 BESS 治疗的 352 例患者。将患者分为两组，POSEH 组和无 POSEH 的正常组（无神经并发症）。分析 e-SBP、人口统计学因素以及术前和术中疑似影响 POSEH 的因素。通过最大曲线下面积（AUC）的阈值水平将 e-SBP 转换为分类变量，ROC 曲线分析。21 例（6.0%）患者服用抗血小板药物（APD），24 例（6.8%）停药，307 例（87.2%）未服用。292 例（83.0%）患者在围手术期使用氨甲环酸（TXA）。
在 352 例患者中，18 例（5.1%）因 POSEH 行翻修手术。POSEH 组和正常组在年龄、性别、诊断、手术节段、手术时间和与凝血相关的实验室检查方面无差异，但 e-SBP 有差异（POSEH 组 163.7 ± 15.7mmHg，正常组 154.1 ± 18.3mmHg）、APD（POSEH 组 4 例服用、2 例停用、12 例未服用，正常组 16 例服用、22 例停用、296 例未服用）和 TXA（POSEH 组 12 例使用、6 例未使用，正常组 280 例使用、54 例未使用）在单变量分析中。ROC 曲线分析中 AUC 最高的是 170mmHg e-SBP（>0.05），为 0.652。高 e-SBP 组（≥170mmHg）94 例，低 e-SBP 组 258 例。多变量逻辑回归分析显示，只有高 e-SBP 是 POSEH 的显著危险因素（=0.013；比值比，3.434）。
高 e-SBP（≥170mmHg）可影响双通道内镜脊柱手术中 POSEH 的发生。
