European Spine Journal

, Volume 28, Issue 1, pp 87–93 | Cite as

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 WatanabeEmail author
Original Article



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).


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.


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°.


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.


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



Lumbar spinal canal stenosis


Postoperative spinal epidural hematoma


Magnetic resonance imaging


Blood pressure


Nonsteroidal anti-inflammatory drug


Japanese Orthopaedic Association


Visual analog scale


Body mass index


Failed back surgery syndrome


American Society of Anesthesiologists physical status




Platelet count and prothrombin time–international normalized ratio


Sagittal vertical axis


Thoracic kyphosis


Lumbar lordosis


Sacral slope


Pelvic tilt


Pelvic incidence


Odds ratios


Confidence interval



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


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
    Email author
  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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