Should We Check the Routine Postoperative MRI for Hematoma in Spinal Decompression Surgery?

Overview

Journal Clin Orthop Surg

Specialty Orthopedics

Date 2017 Jun 2

PMID 28567220

Citations 4

Authors

Hun-Kyu Shin

Hwa-Jae Jeong

Eugene Kim

Jai Hyung Park

Se-Jin Park

Yongun Cho

Affiliations

Soon will be listed here.

Abstract

Background: A postoperative magnetic resonance imaging (MRI) is performed as a routine to assess decompression of the spinal cord as well as to evaluate postoperative complications. The purpose of this study is to analyze the efficacy of postoperative MRI for hematoma in spinal decompression surgery.

Methods: Between January 1, 2008 and January 31, 2015, 185 patients who underwent postoperative MRI after spinal decompression surgery were included in this study. We checked the history of the use of an anticoagulant or antiplatelet agent, withdrawal period, blood platelet count, and prothrombin time (international normalized ratio [INR]). We measured the total amount of suction drainage and duration until removal. We retrospectively reviewed the presence of hematoma and thecal sac compression. Postoperative prognosis was evaluated by a visual analog scale (VAS) and the Oswestry Disability Index (ODI).

Results: Hematomas were found on postoperative MRI scans in 97 out of 185 patients (52.4%). Thirty patients had a thecal sac compressing hematoma: 7 in the cervical spine, 1 in the thoracic spine, and 22 in the lumbar spine. The occurrence of hematoma did not show significant difference according to the use of an anticoagulant ( = 0.157). The blood platelet count, prothrombin time (INR), and suction drainage duration did not have a statistically significant correlation with the occurrence of hematoma ( = 0.562, = 0.506, and = 0.429, respectively). The total amount of suction drainage was significantly different according to the presence of hematoma ( = 0.022). The total 185 patients had a significant decrease in the postoperative VAS score ( < 0.001), and the diminution of VAS score was not significantly different according to the occurrence of hematoma ( = 0.243). Even in the cases of thecal sac compressing hematoma, the reduction of VAS score was not significantly different ( = 0.689).

Conclusions: Postoperative MRI for hematoma in spinal decompression surgery has little effect on prognosis or management. Therefore, indiscriminate postoperative MRI should be avoided and MRI should be performed depending on the patient's status.

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References

Cain Jr J, Major M, Lauerman W, West J, Wood K, Fueredi G . The morbidity of heparin therapy after development of pulmonary embolus in patients undergoing thoracolumbar or lumbar spinal fusion. Spine (Phila Pa 1976). 1995; 20(14):1600-3. DOI: 10.1097/00007632-199507150-00008. View

Platzer P, Thalhammer G, Jaindl M, Obradovic A, Benesch T, Vecsei V . Thromboembolic complications after spinal surgery in trauma patients. Acta Orthop. 2006; 77(5):755-60. DOI: 10.1080/17453670610012944. View

Awad J, Kebaish K, Donigan J, Cohen D, Kostuik J . Analysis of the risk factors for the development of post-operative spinal epidural haematoma. J Bone Joint Surg Br. 2005; 87(9):1248-52. DOI: 10.1302/0301-620X.87B9.16518. View

Liao C, Hsieh P, Lin T, Lin C, Lo Y, Lee S . Surgical treatment of spontaneous spinal epidural hematoma: a 5-year experience. J Neurosurg Spine. 2009; 11(4):480-6. DOI: 10.3171/2009.4.SPINE08904. View

Aono H, Ohwada T, Hosono N, Tobimatsu H, Ariga K, Fuji T . Incidence of postoperative symptomatic epidural hematoma in spinal decompression surgery. J Neurosurg Spine. 2011; 15(2):202-5. DOI: 10.3171/2011.3.SPINE10716. View

Ross J, Masaryk T, Modic M, Bohlman H, Delamater R, Wilber G . Lumbar spine: postoperative assessment with surface-coil MR imaging. Radiology. 1987; 164(3):851-60. DOI: 10.1148/radiology.164.3.3615887. View

Gerlach R, Raabe A, Beck J, Woszczyk A, Seifert V . Postoperative nadroparin administration for prophylaxis of thromboembolic events is not associated with an increased risk of hemorrhage after spinal surgery. Eur Spine J. 2003; 13(1):9-13. PMC: 3468029. DOI: 10.1007/s00586-003-0642-8. View

Kao F, Tsai T, Chen L, Lai P, Fu T, Niu C . Symptomatic epidural hematoma after lumbar decompression surgery. Eur Spine J. 2014; 24(2):348-57. DOI: 10.1007/s00586-014-3297-8. View

Sokolowski M, Garvey T, Perl 2nd J, Sokolowski M, Cho W, Mehbod A . Prospective study of postoperative lumbar epidural hematoma: incidence and risk factors. Spine (Phila Pa 1976). 2008; 33(1):108-13. DOI: 10.1097/BRS.0b013e31815e39af. View

10.

Wen D, Hall W . Complications of subcutaneous low-dose heparin therapy in neurosurgical patients. Surg Neurol. 1998; 50(6):521-5. DOI: 10.1016/s0090-3019(98)00083-4. View

11.

Ahn D, Kim J, Chang B, Lee J . Can We Prevent a Postoperative Spinal Epidural Hematoma by Using Larger Diameter Suction Drains?. Clin Orthop Surg. 2016; 8(1):78-83. PMC: 4761605. DOI: 10.4055/cios.2016.8.1.78. View

12.

Schubert G, Diepers M, Hegewald A, Seiz M, Thome C . Routine postoperative imaging early after lumbar decompression surgery: a prospective evaluation. Spine (Phila Pa 1976). 2013; 38(20):E1263-8. DOI: 10.1097/BRS.0b013e31829fc6a6. View

13.

Babar S, Saifuddin A . MRI of the post-discectomy lumbar spine. Clin Radiol. 2002; 57(11):969-81. DOI: 10.1053/crad.2002.1071. View

14.

Amiri A, Fouyas I, Cro S, Casey A . Postoperative spinal epidural hematoma (SEH): incidence, risk factors, onset, and management. Spine J. 2012; 13(2):134-40. DOI: 10.1016/j.spinee.2012.10.028. View

15.

Grane P . The postoperative lumbar spine. A radiological investigation of the lumbar spine after discectomy using MR imaging and CT. Acta Radiol Suppl. 1998; 414:1-23. View

16.

Malhotra A, Kalra V, Wu X, Grant R, Bronen R, Abbed K . Imaging of lumbar spinal surgery complications. Insights Imaging. 2015; 6(6):579-90. PMC: 4656239. DOI: 10.1007/s13244-015-0435-8. View

17.

Kou J, Fischgrund J, Biddinger A, Herkowitz H . Risk factors for spinal epidural hematoma after spinal surgery. Spine (Phila Pa 1976). 2002; 27(15):1670-3. DOI: 10.1097/00007632-200208010-00016. View

18.

Agnelli G, Piovella F, Buoncristiani P, Severi P, Pini M, DAngelo A . Enoxaparin plus compression stockings compared with compression stockings alone in the prevention of venous thromboembolism after elective neurosurgery. N Engl J Med. 1998; 339(2):80-5. DOI: 10.1056/NEJM199807093390204. View