Peter Chimenti1, Robert Molinari. 1. University of Rochester, Rochester, NY 14642, USA. Peter_chimenti@urmc.rochester.edu
Abstract
BACKGROUND: Subfascial wound suction drains are commonly used after spinal surgery to decrease the incidence of post-operative hematoma. However, there is a paucity of literature regarding their effectiveness. OBJECTIVE: To report four cases of post-operative spinal epidural hematoma causing massive neurological deficit in patients who had subfascial suction wound drains. METHODS: During an 8-year period, a retrospective review of 1750 consecutive adult spinal surgery cases was performed to determine the incidence, commonalities, and outcomes of catastrophic neurological deficit caused by post-operative spinal epidural hematoma. FINDINGS: Epidural hematoma causing major neurological deficit (American Spinal Injury Association B) was identified in 4 out of 1750 patients (0.23%). All four patients in this series had subfascial wound suction drains placed prophylactically at the conclusion of their initial procedure. RESULTS: Three patients developed massive neurological deficits with the drain in place; one patient had the drain removed at 24 hours and subsequently developed neurological symptoms during the following post-operative day. Significant risk factors for the development of hematoma were identified in two of the four patients. Average time to return to the operating room for hematoma evacuation was 6 hours (range 3-12 hours). Neurological status significantly improved in all four patients after hematoma evacuation. CONCLUSIONS: Post-operative epidural hematoma causing catastrophic neurological deficit is a rare complication after spinal surgery. The presence of suction wound drains does not appear to prevent the occurrence of this devastating complication.
BACKGROUND: Subfascial wound suction drains are commonly used after spinal surgery to decrease the incidence of post-operative hematoma. However, there is a paucity of literature regarding their effectiveness. OBJECTIVE: To report four cases of post-operative spinal epidural hematoma causing massive neurological deficit in patients who had subfascial suction wound drains. METHODS: During an 8-year period, a retrospective review of 1750 consecutive adult spinal surgery cases was performed to determine the incidence, commonalities, and outcomes of catastrophic neurological deficit caused by post-operative spinal epidural hematoma. FINDINGS: Epidural hematoma causing major neurological deficit (American Spinal Injury Association B) was identified in 4 out of 1750 patients (0.23%). All four patients in this series had subfascial wound suction drains placed prophylactically at the conclusion of their initial procedure. RESULTS: Three patients developed massive neurological deficits with the drain in place; one patient had the drain removed at 24 hours and subsequently developed neurological symptoms during the following post-operative day. Significant risk factors for the development of hematoma were identified in two of the four patients. Average time to return to the operating room for hematoma evacuation was 6 hours (range 3-12 hours). Neurological status significantly improved in all four patients after hematoma evacuation. CONCLUSIONS: Post-operative epidural hematoma causing catastrophic neurological deficit is a rare complication after spinal surgery. The presence of suction wound drains does not appear to prevent the occurrence of this devastating complication.
Authors: Ralph J Marino; Tarcisio Barros; Fin Biering-Sorensen; Stephen P Burns; William H Donovan; Daniel E Graves; Michael Haak; Lesley M Hudson; Michael M Priebe Journal: J Spinal Cord Med Date: 2003 Impact factor: 1.985
Authors: Mohammad Sami Walid; Moataz Abbara; Abdullah Tolaymat; James R Davis; Kevin D Waits; Joe Sam Robinson; Joe Sam Robinson Journal: World Neurosurg Date: 2011-11-07 Impact factor: 2.104
Authors: Salil B Patel; William Griffiths-Jones; Conor S Jones; Dino Samartzis; Andrew J Clarke; Shahid Khan; Oliver M Stokes Journal: Eur Spine J Date: 2017-02-11 Impact factor: 3.134
Authors: Sapan D Gandhi; Krishn Khanna; Garrett Harada; Philip Louie; James Harrop; Thomas Mroz; Khalid Al-Saleh; Giovanni Barbanti Brodano; Jens Chapman; Michael G Fehlings; Serena S Hu; Yoshiharu Kawaguchi; Michael Mayer; Venugopal Menon; Jong-Beom Park; Shanmuganathan Rajasekaran; Marcelo Valacco; Luiz Vialle; Jeffrey C Wang; Karsten Wiechert; K Daniel Riew; Dino Samartzis Journal: Global Spine J Date: 2020-09-10