척추 수술 후 발생한 척추 경막외 혈종

Abstract

Objectives: Spinal epidural hematoma after spinal surgery is a dreadful complication that can cause major neurologic deficit. We have evaluated factors leading to increased risk for epidural hematoma and its outcome after decompression surgery. Materials and Methods: We retrospectively reviewed 3,720 cases of spine operation over period of 7 years (1998 April~2005 July) where 9 cases of postoperative spinal epidural hematoma were experienced. We evaluated patient factors including underlying medical disease and use of anticoagulation therapy, surgical strategies, and neurological outcome in these patients. Results: The incidence of spinal epidural hematoma after surgery was 0.24%. Their original diagnoses were tumor in 3 cases, cervical stenosis in 2 cases, lumbar stenosis in 3 cases and herniated lumbar disc in 1case. Factors increasing the risk of postoperative epidural hematoma were coagulopathy from medical illness, anticoagulation therapy and surgery of highly vascularized tumor. After decompression for epidural hematoma, clinical outcome varied. Complete recovery was achieved in 3 cases (33.3%), incomplete recovery in 5 cases (55.6%) and no change in 1 case (11.1%). The neurologic recovery after decompression was thought to be related to the preoperative minimal neurological deficit and short interval from diagnosis to decompression. Conclusion: Epidural hematoma following spinal surgery is a rare but devastating complication. Patients with coagulopathy and highly vascularized tumor were more vulnerable to spinal epidural hematoma. The neurologic recovery was related to the degree of preoperative neurological deficit and time interval to the decompression.