Efficacy of hematoma clearance combined with continuous irrigation and drainage on lumbar postoperative symptomatic spinal epidural hematoma
Objective To observe the clinical efficacy and safety of hematoma clearance combined with continuous irrigation and drainage in the treatment of symptomatic spinal epidural hematoma(SSEH)after lumbar spine surgery.Methods Fifteen patients with SSEH after posterior lumbar spinal canal decompression,interbody fusion and internal fixation were treated in Zhengzhou Orthopedic Hospital from January,2017 to March,2023.All patients underwent emergency hematoma removal surgery combined with continuous irrigation and drainage within 6-12 h after diagnosis of SSEH.The preoperative and postoperative white blood cell count,platelet count,hemoglobin,albumin,D-dimer,C-reactive protein and erythrocyte sedimentation rate were recorded.Before and after surgery,the visual analogue scale(VAS)was used to evaluate the degree of pain in the lower back and lower limbs,and the Oswestry Disability Index(ODI)was used to evaluate the lumbar function.After follow-up for 7-18 months,the American Spinal Injury Association(ASIA)grading was used to evaluate the degree of spinal cord nerve function damage before surgery and at the latest follow-up.Results All patients underwent surgery smoothly and were discharged or transferred to the rehabilitation department for rehabilitation treatment after good postoperative incision healing.Among 15 patients,SSEH developed within 1 week after surgery in 13 patients,and 7 to 10 d after surgery in 2;developed before the removal of the drainage tube in 3 patients,and after the removal of the drainage tube in 12.The clinical symptoms included lower limb pain and numbness in 12 patients,weakened lower limb muscle strength in 8,urinary and bowel dysfunction in 3,and unable to lie down due to incision swelling and pain.The ASIA was grade B in 2 patients,grade C in 5,and grade D in 8.During surgery,2 patients were found active bleeding from the venous plexus within the spinal canal,2 were found blood clots blocking the opening of the drainage tube,1 was found the drainage tube folded within the incision,and 10 were found a large amount of blood clots attaching to the surface of the hemostatic material,compressing the dura mater but without obvious bleeding points.The white blood cell count was lower 2 weeks after surgery than that before surgery,1 d after surgery,and 1 week after surgery(P＜0.05),and showed no significant difference before surgery,1 d after surgery and 1 week after surgery(P＞0.05).The platelet count was higher 1 week and 2 weeks after surgery than that before and 1 d after surgery(P＜0.05),and showed no significant difference 1 week after surgery compared with that 2 weeks after surgery,and 1 d after surgery compared with that before surgery(P＞0.05).The albumin level was lower 1 d after surgery than that before surgery(P＜0.05),were higher 1 week and 2 weeks after surgery than that 1 d after surgery(P＜0.05),and showed no significant difference before surgery,and 1 week and 2 weeks after surgery(P＞0.05).The D-dimer level was lower 1 d,1 week and 2 weeks after surgery than that before surgery(P＜0.05),were lower 1 week and 2 weeks after surgery than that 1 d after surgery(P＜0.05),and showed no significant difference 1 week and 2 weeks after surgery(P＞0.05).The C-reactive protein level was lower 1 week and 2 weeks after surgery than that 1 d after surgery(P＜0.05),was lower 2 weeks after surgery than that before surgery(P＜0.05),and showed no significant difference 1 d and 1 week after surgery compared with that before surgery,and 2 week after surgery compared with that 1 week after surgery(P＞0.05).There were no significant differences in the hemoglobin and erythrocyte sedimentation rate before surgery,and 1 d,1 week and 2 weeks after surgery(P＞0.05).The VAS scores for lower back pain(7.07±1.16,3.47±1.06,1.40±0.74,0.67±0.62),VAS scores for lower limb pain(6.00±2.07,3.00±1.56,1.07±0.80,0.47±0.42),and ODI scores[(57.20±13.00)％,(41.20±12.80)％,(26.40±11.91)％,(14.93±9.00)％]decreased sequentially in turn before surgery,1 week after surgery,3 months after surgery,and at the latest follow-up(P＜0.05).The median follow-up time was 14 months.No postoperative complications occurred such as incision infection,poor healing,recurrent hematoma,or loosening of internal fixation.At the latest follow-up,ASIA grade recovered from B to C in 1 patient,from B to D in 1,from C to D in 2,from C to E in 3,and from D to E in 7,and 1 patient remained in grade D.Conclusion The combination of hematoma removal surgery and continuous irrigation and drainage can effectively remove hematoma,alleviate lower back and lower limb pain,restore neurological function,reduce the risk of postoperative infection and hematoma recurrence,and have a high safety.
lumbar spine surgerysymptomatic spinal epidural hematomahematoma clearancecontinuous irrigation and drainage
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