Study Design Prospective clinical series Objective To determine the incidence, volume, and extent of postoperative epidural hematoma resulting (n thecal sac compression, and to identify' risk factors correlated with measured hematoma volumes of Background Data Risk factors for postoperative hentatoma development have been retrospectively determined in small populations of symptomatic patients A prospective study of hematoma characteristics and associated risk factors in a consecutive series of patients could significantly enhance our understanding of of postoperative hematoma Methods Preoperative magnetic resonance imaging and clinical data on 13 pre- and intraoperative risk factors were prospectively collected on 50 consecutive patients undergoing lumbar decompression surgery with or without fusion Postoperative magnetic resonance imagings were performed within 2 to 5 clays of surgery Thecal sac cross-sectional area was calculated at each disc space Relative thecal sac compression due to hematoma was calculated at all levels where postoperative cross-sectional area was smaller than preoperative Hematoma volumes were calculated Multivariate analysis identified risk factors associated with postoperative hematoma volume Results After decompression, 58% of patients developed epidural hematoma of sufficient magnitude to compress the thecal sac beyond its preoperative state at one or more levels None developed new postoperative neurologic deficits A mean of 14 levels were decompressed Hematoma expended over a mean of 19 levels Maximal thecal sac compression due to hematoma occurred at an adjacent, nondecompressed level in 28% of patients Multivariate analysis found age greater than 60, multilevel procedures, and preoperative international normalized ratio to be associated with larger hematoma volumes Conclusion Lumbar decompression surgery results in a 58% incidence of asymptomatic compressive postoperative epidural hematoma Adjacent level compression by hematoma occurs in 28% of patients Advanced age, multilevel procedures, and international normalized ratio are independently associated with postoperative hematoma volume

Prospective Study of Postoperative Lumbar Epidural Hematoma : Incidence and Risk Factors

Object Neurological deterioration due to spinal epidural hematoma (SEH) is a rare but significant complication of spinal surgery. The frequency of hematoma evacuation after spinal surgery is reportedly 0.1%–3%. The objective of this study was to investigate the symptomatology of SEH and the frequency of evacuation for each surgical procedure after spinal decompression surgery. Methods This is a retrospective study of 26 patients who underwent SEH evacuation after spinal decompression surgery between 1986 and 2005. During this period, 6356 spinal decompression surgeries were performed. The factors studied were the frequency of SEH evacuation for each surgical procedure, symptoms, time to SEH evacuation, comorbidities, and neurological recovery. Results The frequency of SEH evacuation was 0.41% (26 of 6356) for all operations. The frequency for each surgical procedure was 0% (0 of 1568) in standard lumbar discectomy, 0.50% (8 of 1614) in lumbar laminectomy, 0.67% (8 of 1191) in posterior lumbar interbody fu...

Incidence of postoperative symptomatic epidural hematoma in spinal decompression surgery.

We analysed prospectively 26 patients who had revision operations for ipsilateral recurrent radicular pain after a period of pain relief of more than six months following primary discectomy. They were assessed before the initial operation, between the two procedures and at a minimum of two years after reoperation. MRI was performed before primary discectomy and reoperation. Fifty consecutive patients who had a disc excision during the study period but did not have recurrent radicular pain, were analysed as a control group. Of the study group 42% related the onset of recurrent radicular pain to an isolated injury or a precipitating event, but none of the control group did so (p 0.05). Work or daily activities had been resumed at the same level as before the onset of symptoms by 81% of the patients in the study group and 84% of the control group. No correlation was found between the amount of epidural fibrosis, as seen intraoperatively and on MRI, and the result of surgery. The recurrence of radicular pain caused no significant changes in the psychological profile compared with the assessment before the primary discectomy.

Ipsilateral recurrent lumbar disc herniation: A PROSPECTIVE, CONTROLLED STUDY

The previous two decades have resulted in substantial technological advancements in neuroradiological imaging. New non-invasive imaging modalities have been developed and existing modalities have been refined, rendering exploratory operations on the spine obsolete. The ubiquitous availability of modalities for improved anatomical visualization of the spine, however, may lead to overutilization and inappropriate application in an area such as lumbar degenerative disorders, which may affect 60 to 80 per cent of the population.

Errors in clinical decision-making after radiographic investigation of the lumbar spine may arise in one of three general areas: (1) the timing of the application of the study during the patient's clinical course, (2) the matching of the clinical indications to the choice of the optimum imaging study, and (3) the precise correlation of the abnormalities seen on imaging with the clinical symptoms. The goals of this article are to review the general principles of imaging of the spine and to discuss each within the context of the most common clinical presentations of degenerative spinal disorders: low-back pain, pain in the lower limb, and pain after spinal procedures.

As with any diagnostic test, the ideal time to perform an imaging study of the lumbar spine is when the information that is obtained will affect the treatment plan. The appropriate timing may vary according to the diagnosis and patient-related factors. Because of the continuously changing anatomy (such as the shrinking of disc herniations and degenerative changes in the marrow), imaging studies should not be performed prematurely. Major resorption of a herniated lumbar disc can occur in just a few months, rendering the imaging study outdated as a guide for operative planning16,34.

I believe that diagnostic imaging studies should be used to confirm the information gathered from a thorough history and physical examination. As a rule, …

The use of radiographic imaging studies in the evaluation of patients who have degenerative disorders of the lumbar spine.

Lumbar spine surgery for spinal stenosis is a frequently performed procedure and was the fastest growing type of surgery in the US from 1980 to 2000. With increasing surgical invasiveness, postoperative complications also tend to be higher. Cross-sectional imaging techniques (CT and MRI) are more sensitive than radiographs and play an increasingly important role in evaluation of patients with lumbar spine surgery. Their use in patients with metallic implants is somewhat limited by artefacts, which can obscure pathology and decrease accuracy and reader confidence. Metal artefact reduction techniques have been developed, which can significantly improve image quality and enable early detection of postoperative complications. Complications can occur throughout postoperative course. Early complications include hardware displacement, incidental durotomy, postoperative collections—most commonly seroma, and less likely haematoma and/or infection. Incidental durotomy with CSF leak causing intracranial hypotension has characteristic MR brain findings and diagnosis of occult leak sites have been improved with use of dynamic CT myelography. Haematomas, even when compressing the thecal sac, are usually asymptomatic. Early infection, with nonspecific MR findings, can be diagnosed accurately using dual radiotracer studies. Delayed complications include loosening, hardware failure, symptomatic new or recurrent disc herniation, peri-/epidural fibrosis, arachnoiditis, and radiculitis. • CT and MRI play an increasingly important role in evaluation of patients with lumbar spine surgery
 • Complications can occur throughout the postoperative course and early detection is critical
 • Artefact reduction techniques can improve image quality for early and improved detection of complications

/pdf/imaging-of-lumbar-spinal-surgery-complications-5b3sfu2fen.pdf

Imaging of lumbar spinal surgery complications

Imaging the lumbar spine after surgery for disk herniation is all too often an unrewarding challenge. A constellation of findings is inevitable, and determining their significance is often impossible. The challenge is greatest during the first few months following surgery, when the rules of scar enhancement, deformity, and mass effect do not apply to differentiation of the abnormal from the normal. A clear understanding of normal postoperative healing is necessary to avoid overreaction to misleading findings. This report reviews imaging of the lumbar spine in the early postoperative period (i.e., the first 6 months after surgery), focusing on the normal healing process that so often mimics complicating or recurrent disease.

/pdf/lumbar-spine-after-surgery-for-herniated-disk-imaging-3d4py7n9st.pdf

Lumbar spine after surgery for herniated disk: imaging findings in the early postoperative period.

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Lumbar spine after surgery for herniated disk: imaging findings in the early postoperative period.