Post-Operative Spinal Epidural Hematoma after Thoracic and Lumbar Spinous Process-Splitting Laminectomy for Thoracic and Lumbar Spinal Stenosis

Abstract

Introduction: To investigate the risk of epidural hematoma after spinous process-splitting laminectomy (SPSL).

Methods: A total of 137 cases (mean age, 72.4 years; 68 men) of SPSL were included. Of these, there were instances (3.7%; mean age, 70.5 years; all male) of postoperative development of new neurologic deficit due to epidural hematoma requiring reoperation. The 133 subjects (72.5 years; 64 men) with normal postoperative course were used as controls, and comparisons were made between both groups using chi-squared and Student's t-tests. Regarding our investigation of risk factors for epidural hematoma, logistic regression was conducted with presence or absence of hematoma as our primary outcome variable, and age, gender, disease duration, number of laminectomies, which levels were decompressed, blood loss, length of case, drain output, coagulopathy, and whether or not there was an intraoperative dural tear were our explanatory variables.

Results: All cases of hematoma were single-level laminectomies; there was one case of T9-10 and 3 cases of L2-3. In our direct comparison of both groups (hematoma versus control), the proportion of men was significantly higher in the hematoma group (100% versus 48%, p < 0.05); levels decompressed were also significantly higher (p < 0.05) in the hematoma group, and drain outputs were significantly lower (113 mL versus 234 mL, p < 0.05). From our logistic regression analysis, the levels were significantly higher (χ² = 15, p = 0.0001) and the drain outputs were smaller (χ² = 4.6, p = 0.03) in the hematoma group.

Conclusions: Single-level decompression higher than the L2-3 level and reduced drain output were risk factors for spinal epidural hematoma. With this method of spinous process suturing and reconstruction there is less decompression compared with more conventional methods; therefore, the effect of hematoma may be more pronounced at higher vertebral levels with reduced canal width, and drain failure may also occur with this limited space.

Keywords: lumbar spinal stenosis; risk factors; spinal epidural hematoma; spinous process-splitting laminectomy.

Figure 1.

A 72-year-old man before and after a lumbar L2-3 spinous process-splitting laminectomy: Magnetic resonance imaging (A, C, D-C) and CT (B). (A) Preoperative T2-weighted sagittal MRI showing L2-3 spinal stenosis; (B) Postoperative 3-D CT reconstruction of the lumbar spine; arrow at the level of L2-3 decompression; (C) Postoperative T2-weighted sagittal MRI showing epidural hematoma (arrow head) ascending to the level of L1; (D) T2-weighted axial MRI showing the L2-3 level in the setting of postoperative paralysis.