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Impact of lumbar hypolordosis on the incidence of symptomatic postoperative spinal epidural hematoma after decompression surgery for lumbar spinal canal stenosis

  • Nobuyuki Fujita
  • Takehiro Michikawa
  • Mitsuru Yagi
  • Satoshi Suzuki
  • Osahiko Tsuji
  • Narihito Nagoshi
  • Eijiro Okada
  • Takashi Tsuji
  • Masaya Nakamura
  • Morio Matsumoto
  • Kota Watanabe
Original Article

Abstract

Purpose

Potential associations between radiographic parameters and the incidence of symptomatic postoperative spinal epidural hematoma (PSEH) have not been identified. This study aimed to identify risk factors including radiographic parameters for symptomatic PSEH after posterior decompression surgery for lumbar spinal canal stenosis (LSS).

Methods

We retrospectively reviewed 1007 consecutive patients who underwent lumbar decompression surgery for lumbar spinal canal stenosis (LSS) at our institution. We identified 35 cases of symptomatic PSEH, defined by clinical symptoms and MRI findings, and selected 3 or 4 age- and sex-matched control subjects for each PSEH subject (124 controls). We compared radiographic parameters and previously reported risk factors between PSEH and control subjects.

Results

Compared to the control group, PSEH patients had significantly higher preoperative systolic (p = .020) and diastolic (p = .048) blood pressure, and more levels of decompression (p = .001). PSEH and control subjects had significant differences in lumbar lordosis (PSEH 24.8° ± 14.6°, control 34.8° ± 14.5°), pelvic tilt (25.1° ± 11.7° vs. 20.8° ± 8.4°), sacral slope (23.4° ± 9.4° vs. 27.6° ± 8.3°), and pelvic incidence minus lumbar lordosis (23.7° ± 15.0° vs. 13.7° ± 14.6°). Multivariate analysis revealed two significant risk factors for PSEH: decompression of two or more levels and lumbar lordosis < 25°.

Conclusions

Multilevel decompression and hypolordosis are significant risk factors for symptomatic PSEH after decompression surgery for LSS. LSS patients with lumbar hypolordosis or multilevel stenosis should be carefully observed for PSEH after decompression surgery.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

Keywords

Symptomatic postoperative spinal epidural hematoma Decompression surgery Lumbar spinal stenosis Radiographic parameters Lumbar hypolordosis 

Abbreviations

LSS

Lumbar spinal canal stenosis

PSEH

Postoperative spinal epidural hematoma

MRI

Magnetic resonance imaging

BP

Blood pressure

NSAID

Nonsteroidal anti-inflammatory drug

JOA

Japanese Orthopaedic Association

VAS

Visual analog scale

BMI

Body mass index

FBSS

Failed back surgery syndrome

ASA

American Society of Anesthesiologists physical status

HTN

Hypertension

PT/INR

Platelet count and prothrombin time–international normalized ratio

SVA

Sagittal vertical axis

TK

Thoracic kyphosis

LL

Lumbar lordosis

SS

Sacral slope

PT

Pelvic tilt

PI

Pelvic incidence

OR

Odds ratios

CI

Confidence interval

Notes

Acknowledgements

The authors wish to thank Dr. Ken Ninomiya (Department of Orthopaedic Surgery, Tokyo Dental College Ichikawa General Hospital) for his critical advice on the study design and Dr. Aiko Sakurai (Department of Orthopaedic Surgery, Keio University School of Medicine) for her support to the collection of data.

Sources of Funding

None.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

586_2018_5782_MOESM1_ESM.pptx (137 kb)
Supplementary material 1 (PPTX 136 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Nobuyuki Fujita
    • 1
    • 4
  • Takehiro Michikawa
    • 2
  • Mitsuru Yagi
    • 1
    • 4
  • Satoshi Suzuki
    • 1
    • 4
  • Osahiko Tsuji
    • 1
    • 4
  • Narihito Nagoshi
    • 1
    • 4
  • Eijiro Okada
    • 1
    • 4
  • Takashi Tsuji
    • 3
    • 4
  • Masaya Nakamura
    • 1
    • 4
  • Morio Matsumoto
    • 1
    • 4
  • Kota Watanabe
    • 1
    • 4
  1. 1.Department of Orthopaedic SurgeryKeio University School of MedicineTokyoJapan
  2. 2.Department of Environmental and Occupational Health, School of MedicineToho UniversityTokyoJapan
  3. 3.Department of Orthopaedic Surgery, School of MedicineFujita Health UniversityAichiJapan
  4. 4.Keio Spine Research Group (KSRG)TokyoJapan

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