Impact of lumbar hypolordosis on the incidence of symptomatic postoperative spinal epidural hematoma after decompression surgery for lumbar spinal canal stenosis
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.
KeywordsSymptomatic postoperative spinal epidural hematoma Decompression surgery Lumbar spinal stenosis Radiographic parameters Lumbar hypolordosis
Lumbar spinal canal stenosis
Postoperative spinal epidural hematoma
Magnetic resonance imaging
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
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.
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