Causes and curative strategy of symptomatic spinal epidural hematoma after spine surgery

Objective:To study the causes and curative strategy of symptomatic spinal epidural hematoma(SSEH) after spine surgery． Methods:Seven patients suffering from SSEH after spine surgery were included in the study，and 30 patients with no SSEH after spine surgery by the same surgeon in the same period acted as control． Both groups were administrated low-molecular-weight-heparin after operation． Seven cases developed SSEH after the surgery and three of them were administered dextran-40 combined with low-molecular- weight-heparin;5 cases developed SSEH before the drainage tubes were removed． The age of the patients，number of the operated segments and blood loss during the operation were compared between the two groups． The nervous function score and the recovery rate were compared between the two groups to find out the association of the recovery outcome with the duration of hematoma and the nervous function before the hematoma was cleared． Results:The patients' age and number of the operated segments were not statistically different between the two groups(P ＞0． 05)，and there was more blood loss in the case group(P 0． 01)． The duration of symptom and the American Spinal Injury Association SIA sensory score before hematoma evacuation were not statistically different between the patients with complete recovery of the neurological function and those with incomplete recovery(P0． 05);but the American Spinal Injury Association motor score of patients with complete recovery was higher than that of patients with incomplete recovery(P 0． 05)． Conclusions:Improper use of anticoagulant，blood loss during operation and inadequate drainage are the risk factors for SSEH after spine surgery． Once SSEH occurs，hematoma evacuation should be immediately conducted to decompress the nerves．