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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

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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

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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

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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.

Funding

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan

    Nobuyuki Fujita, Mitsuru Yagi, Satoshi Suzuki, Osahiko Tsuji, Narihito Nagoshi, Eijiro Okada, Masaya Nakamura, Morio Matsumoto & Kota Watanabe

  2. Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo, Japan

    Takehiro Michikawa

  3. Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Aichi, Japan

    Takashi Tsuji

  4. Keio Spine Research Group (KSRG), Tokyo, Japan

    Nobuyuki Fujita, Mitsuru Yagi, Satoshi Suzuki, Osahiko Tsuji, Narihito Nagoshi, Eijiro Okada, Takashi Tsuji, Masaya Nakamura, Morio Matsumoto & Kota Watanabe

Authors
  1. Nobuyuki Fujita
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  2. Takehiro Michikawa
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  3. Mitsuru Yagi
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  4. Satoshi Suzuki
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  5. Osahiko Tsuji
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  6. Narihito Nagoshi
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  7. Eijiro Okada
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  8. Takashi Tsuji
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  9. Masaya Nakamura
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  10. Morio Matsumoto
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  11. Kota Watanabe
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Corresponding author

Correspondence to Kota Watanabe.

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The authors declare that they have no conflict of interest.

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Fujita, N., Michikawa, T., Yagi, M. et al. Impact of lumbar hypolordosis on the incidence of symptomatic postoperative spinal epidural hematoma after decompression surgery for lumbar spinal canal stenosis. Eur Spine J 28, 87–93 (2019). https://doi.org/10.1007/s00586-018-5782-y

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  • DOI: https://doi.org/10.1007/s00586-018-5782-y

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