P47. Acute postoperative epidural hematomas in minimally invasive lumbar fusions: A prospective comparative cohort study

• Published in: The spine journal 2022-09, Vol.22 (9), p.S149-S149
• Main Authors: Kaufmann, Ascher, Lytle, Evan J, Claus, Chad, Anton, Gustavo, Tong, Doris W., Carr, Daniel A, Soo, Teck-Mun
• Format: Article
• Language: English
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2022.07.003

The incidence of postoperative spinal epidural hematomas (SEH) in open lumbar decompression/fusions has been reported to be up to 89%. However, the incidence of asymptomatic SEH and the radiographic parameters predicting symptomatic SEH in minimally invasive transforaminal lumbar interbody fusions (MiTLIF) has not been established. To determine the incidence of asymptomatic epidural compression/SEH and the radiologic parameters which predict compression/SEH becoming symptomatic. Prospective comparative cohort study performed at a community hospital. Forty-two consecutive patients undergoing MiTLIFs at a single institution from 2017-2018. Exclusions were >3 operative levels, revision spinal fusion, perioperative intake of Aspirin/Plavix/NSAID, abnormal clotting profile or hardware malpositioning. Our primary outcome was the incidence of epidural compression/SEH and the associated radiographic parameters. The onset of pain and neurological deficits was evaluated daily. MRI was performed. Thirty patients were enrolled in the asymptomatic group and 12 in the symptomatic group. Eight (26.67%) asymptomatic patients had postoperative thecal sac compression. Symptomatic patients had a significantly higher BMI compared to asymptomatic patients (34.6 ± 7.4 vs 28.2 ± 5.4, p=.010). Four of the asymptomatic patients had SEH (13.3%, 95%CI: 3.8–30.7). Comparing symptomatic vs asymptomatic compression, there were significant differences for the CR (0.57 ± 0.20 vs 1.08 ± 0.53, Δ 95%CI: -.84 - -.19, p