Yan Xin, Yan Li-Rong, Ma Zhi-Gang, Jiang Ming, Gao Yang, Pang Ying, Wang Wei-Wei, Qin Zhao-Hui, Han Yang-Tong, You Xiao-Fan, Ruan Wei, Wang Qian
Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China.
Medical Record Management and Statistics, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China.
World J Clin Cases. 2023 Aug 16;11(23):5430-5439. doi: 10.12998/wjcc.v11.i23.5430.
Intracranial hemorrhage after spinal surgery is a rare and devastating complication.
To investigate the economic burden, clinical characteristics, risk factors, and mechanisms of intracranial hemorrhage after spinal surgery.
A retrospective cohort study was conducted from January 1, 2015, to December 31, 2022. Patients aged ≥ 18 years, who had undergone spinal surgery were included. Intracranial hemorrhage patients were selected after spinal surgery during hospitalization. Based on the type of spinal surgery, patients with intracranial hemorrhage were randomly matched in a 1:5 ratio with control patients without intracranial hemorrhage. The patients' pre-, intra-, and post-operative data and clinical manifestations were recorded.
A total of 24472 patients underwent spinal surgery. Six patients (3 males and 3 females, average age 71.3 years) developed intracranial hemorrhage after posterior spinal fusion procedures, with an incidence of 0.025% (6/24472). The prevailing type of intracranial hemorrhage was cerebellar hemorrhage. Two patients had a poor clinical outcome. Based on the type of surgery, 30 control patients were randomly matched in 1:5 ratio. The intracranial hemorrhage group showed significant differences compared with the control group with regard to age (71.33 ± 7.45 years 58.39 ± 8.07 years, = 0.001), previous history of cerebrovascular disease (50% 6.7%, = 0.024), spinal dura mater injury (50% 3.3%, = 0.010), hospital expenses (RMB 242119.1 ± 87610.0 RMB 96290.7 ± 32029.9, = 0.009), and discharge activity daily living score (40.00 ± 25.88 75.40 ± 18.29, = 0.019).
The incidence of intracranial hemorrhage after spinal surgery was extremely low, with poor clinical outcomes. Patient age, previous stroke history, and dura mater damage were possible risk factors. It is suggested that spinal dura mater injury should be avoided during surgery in high-risk patients.
脊柱手术后颅内出血是一种罕见且严重的并发症。
探讨脊柱手术后颅内出血的经济负担、临床特征、危险因素及机制。
进行一项回顾性队列研究，研究时间为2015年1月1日至2022年12月31日。纳入年龄≥18岁且接受过脊柱手术的患者。选取住院期间脊柱手术后发生颅内出血的患者。根据脊柱手术类型，将颅内出血患者与未发生颅内出血的对照患者按1:5的比例进行随机匹配。记录患者术前、术中和术后的数据及临床表现。
共有24472例患者接受了脊柱手术。6例患者（3例男性，3例女性，平均年龄71.3岁）在脊柱后路融合手术后发生颅内出血，发生率为0.025%（6/24472）。颅内出血的主要类型为小脑出血。2例患者临床结局较差。根据手术类型，按1:5的比例随机匹配30例对照患者。颅内出血组与对照组在年龄（71.33±7.45岁对58.39±8.07岁，P=0.001）、既往脑血管疾病史（50%对6.7%，P=0.024）、脊柱硬脑膜损伤（50%对3.3%，P=0.010）、住院费用（242119.1±87610.0元对96290.7±32029.9元，P=0.009）及出院时日常生活活动评分（40.00±25.88对75.40±18.29，P=0.019）方面存在显著差异。
脊柱手术后颅内出血的发生率极低，临床结局较差。患者年龄、既往卒中史和硬脑膜损伤可能是危险因素。建议在高危患者手术过程中避免脊柱硬脑膜损伤。
