APHM, UH Timone, Department of Neurosurgery, Aix Marseille Univ, Marseille, France.
Laboratory of Biomechanics and Application, UMRT24, Gustave Eiffel University, Aix Marseille University, Marseille, France.
Neurosurg Rev. 2024 May 24;47(1):233. doi: 10.1007/s10143-024-02468-z.
Symptomatic spinal epidural hematoma (SSEH) is one of the most feared complications and source of litigation in spine surgery. Its occurrence rises up to 2% in minimally invasive spine surgery. In parts of the world where the population is aging, more fragile patients are expected to undergo degenerative spine surgery. Management of the SSEH includes emergent spine MRI, though some experts advocate for direct second-look surgery without imaging. Then, an urgent revision surgery under general anesthesia for hematoma evacuation is warranted. We report the case of a threatening SSEH in an 88-year-old patient after lumbar spine stenosis surgery. In order to spare a second general anesthesia for this fragile patient, we opted for a percutaneous ultra-sound guided drainage of the hematoma under local anesthesia as a first line treatment. The procedure was successful, we report an instant relief of his neurological deficit while performing the procedure.
Ultra-sound guided percutaneous drainage of hyperacute SSEH successfully avoided a revision surgery. It spared a second general anesthesia in a fragile patient. This procedure could be an alternative first-line treatment of SSEH for fragile patients.
症状性脊髓硬膜外血肿（SSEH）是脊柱手术中最可怕的并发症之一，也是引发诉讼的主要原因。在微创手术中，其发生率上升至 2%。在人口老龄化的地区，预计更多脆弱的患者将接受退行性脊柱手术。SSEH 的治疗包括紧急脊柱 MRI，尽管有些专家主张在不进行影像学检查的情况下直接进行二次探查手术。然后，需要在全身麻醉下进行紧急revision 手术以清除血肿。我们报告了一例 88 岁老年患者腰椎狭窄手术后出现威胁性 SSEH 的病例。为了避免对这位脆弱的患者进行第二次全身麻醉，我们选择在局部麻醉下进行经皮超声引导下血肿引流作为一线治疗。该操作取得了成功，在进行操作的同时，患者的神经功能缺损得到了即刻缓解。
超急性 SSEH 的超声引导经皮引流成功地避免了 revision 手术。它为脆弱的患者节省了第二次全身麻醉。对于脆弱的患者来说，该操作可能是 SSEH 的一线治疗替代方法。
