Relevance of Postoperative Magnetic Resonance Images in Evaluating Epidural Hematoma After Thoracic Fixation Surgery

• Published in: World neurosurgery 2017-11, Vol.107, p.803-808
• Main Authors: Shin, Hong Kyung, Choi, Il, Roh, Sung Woo, Rhim, Seung Chul, Jeon, Sang Ryong
• Format: Article
• Language: English
• Subjects: Adult; Aged; Bone Screws; Decompression, Surgical; Female; Hematoma, Epidural, Spinal - diagnostic imaging; Hematoma, Epidural, Spinal - etiology; Hematoma, Epidural, Spinal - surgery; Humans; Laminectomy; Magnetic resonance image; Magnetic Resonance Imaging; Male; Middle Aged; Muscle Weakness - diagnostic imaging; Muscle Weakness - etiology; Postoperative epidural hematoma; Postoperative Period; Retrospective Studies; Spinal cord compression; Spinal Cord Compression - diagnostic imaging; Spinal Cord Compression - etiology; Spinal Fusion; Thoracic fixation surgery; Thoracic Vertebrae - diagnostic imaging; Thoracic Vertebrae - surgery; Titanium
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2017.08.097

It is difficult to evaluate the significant findings of epidural hematoma in magnetic resonance images (MRIs) obtained immediately after thoracic posterior screw fixation (PSF). Prospectively, immediate postoperative MRI was performed in 10 patients who underwent thoracic PSF from April to December 2013. Additionally, we retrospectively analyzed the MRIs from 3 patients before hematoma evacuation out of 260 patients who underwent thoracic PSF from January 2000 to March 2013. The MRI findings of 9 out of the 10 patients, consecutively collected after thoracic PSF, showed neurologic recovery with a well-preserved cerebrospinal fluid (CSF) space and no prominent hemorrhage. Even though there were metal artifacts at the level of the pedicle screws, the preserved CSF space was observed. In contrast, the MRI of 1 patient with poor neurologic outcome demonstrated a typical hematoma and slight spinal cord compression and reduced CSF space. In the retrospective analysis of the 3 patients who showed definite motor weakness in the lower extremities after their first thoracic fusion surgery and underwent hematoma evacuation, the magnetic resonance images before hematoma evacuation also revealed hematoma compressing the spinal cord and diminished CSF space. This study shows that epidural hematomas can be detected on MRI performed immediately after thoracic fixation surgery, despite metal artifacts and findings such as hematoma causing spinal cord compression. Loss of CSF space should be considered to be associated with neurologic deficit.