Correlation between Neurologic Recovery and Timing of Surgical Decompression of Post-Operative Spinal Epidural Hematoma (POSEH)

Background: The incidence of postoperative spinal epidural hematoma requiring evacuation ranges from 0.1% to 3%. Although rare, these haematomas can have devastating consequences. Studies of the effect of the magnitude and duration of cord compression in humans have produced conflicting results. Purpose: Identify the correlation between neurologic recovery and timing of surgical decompression of(POSEH}.

Methods: 14,932 patients underwent spinal surgery between 1984 to 2002 at our institution and met the inclusion criteria. 32 patients (0.2%) developed POSEH and had some degree of neurological compromise.

Results: The average time between surgery and evacuation of the hematoma was 79.9 hours. The average time from onset of symptoms to second operation was 18.6 hours. There was no difference in bowel or bladder dysfunction across time categories at preoperative (Chi-square (3 d.f.) = 5.00, p=.172) or at first day postoperative (Chi-square (3 d.f.) = 3.41, p=.332). There was no correlation between time from surgery to symptoms and neurologic recovery (NR). There was no correlation between age and (NR)(rho=.001, p=.995), time from index surgery to symptoms (rho=0.064, p=.737). There was no gender correlation. The change in Frankel Grade following hematoma evacuation (HE), those with time from onset of symptoms to (HE) <6 hours had a mean improvement of 0.13 , those with time from onset symptoms to (HE) 6-12 an 0.38, and 12-24 0.22. Conversely,>24 hours had a decline of -0.50.

Conclusions: The incidence of (POSEH) ranges from 0.1% to 3%. Neurologic recovery correlated with the time from the onset of neurologic symptoms (HE). There was no significant difference in neurologic recovery if (HE} was performed within 24 hours. However if (HE) was delayed beyond 24 hours, neurologic recovery was less likely to occur.