STUDY DESIGN: A multicentered retrospective case series.
OBJECTIVE: To determine the incidence and circumstances surrounding the development of a symptomatic postoperative epidural hematoma in the cervical spine.
METHODS: Patients who underwent cervical spine surgery between January 1, 2005, and December 31, 2011, at 23 institutions were reviewed, and all patients who developed an epidural hematoma were identified.
RESULTS: A total of 16 582 cervical spine surgeries were identified, and 15 patients developed a postoperative epidural hematoma, for a total incidence of 0.090%. Substantial variation between institutions was noted, with 11 sites reporting no epidural hematomas, and 1 site reporting an incidence of 0.76%. All patients initially presented with a neurologic deficit. Nine patients had complete resolution of the neurologic deficit after hematoma evacuation; however 2 of the 3 patients (66%) who had a delay in the diagnosis of the epidural hematoma had residual neurologic deficits compared to only 4 of the 12 patients (33%) who had no delay in the diagnosis or treatment (P = .53). Additionally, the patients who experienced a postoperative epidural hematoma did not experience any significant improvement in health-related quality-of-life metrics as a result of the index procedure at final follow-up evaluation.
CONCLUSION: This is the largest series to date to analyze the incidence of an epidural hematoma following cervical spine surgery, and this study suggest that an epidural hematoma occurs in approximately 1 out of 1000 cervical spine surgeries. Prompt diagnosis and treatment may improve the chance of making a complete neurologic recovery, but patients who develop this complication do not show improvements in the health-related quality-of-life measurements.
Recommended CitationSchroeder, Gregory D.; Hilibrand, Alan S.; Arnold, Paul M.; Fish, David E.; Wang, Jeffrey C.; Gum, Jeffrey L.; Smith, Zachary A.; Hsu, Wellington K.; Gokaslan, Ziya L.; Isaacs, Robert E.; Kanter, Adam S.; Mroz, Thomas E.; Nassr, Ahmad; Sasso, Rick C.; Fehlings, Michael G.; Buser, Zorica; Bydon, Mohamad; Cha, Peter I.; Chatterjee, Dhananjay; Gee, Erica L.; Lord, Elizabeth L.; Mayer, Erik N.; McBride, Owen J.; Nguyen, Emily C.; Roe, Allison K.; Tortolani, P. Justin; Stroh, D. Alex; Yanez, Marisa Y.; and Riew, K. Daniel, "Epidural Hematoma Following Cervical Spine Surgery." (2017). Rothman Institute Faculty Papers. Paper 88.
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