J Korean Soc Spine Surg.  2002 Dec;9(4):347-355. 10.4184/jkss.2002.9.4.347.

Early Decompressive Surgery for Compressive Neuropathy by Hematoma after Posterior Spinal Decompressive Surgery

• Kim YM
• Won CH
• Choi ES
• Cho BK

• KMID: 2209717
• DOI: http://doi.org/10.4184/jkss.2002.9.4.347

Abstract

STUDY DESIGN: A retrospective analysis was performed to identify the diagnostic and therapeutic factors related to postoperative compressive neuropathy by hematoma after posterior spinal decompressive surgery.
OBJECTIVES
To document by analysis the clinical course of postoperative compressive neuropathy by hematoma, the efficacy of early surgical decompression, and to recommend methods of prevention. SUMMARY OF LITERATURE REVIEW: Various diagnostic and treatment modalities have been applied to postoperative compressive neuropathy after spinal surgery. However, the timing of surgical decompression remains controversial.
MATERIALS AND METHODS
Five cases of postoperative compressive neuropathy after posterior spinal decompressive surgery, which occurred from May 1996 to May 2000, were investigated in terms of causes, clinical courses, and management profiles after early surgical decompression, and final outcome.
RESULTS
Five cases (2.14%) among 234 patients were managed by re-decompression including the evacuation of hematoma. Four cases, which had been managed by earlier surgical decompression showed neurologic improvement after 2 postoperative weeks, and achieved favorable clinical results without grave neurologic sequelae. However, in one case, in which surgical decompression had been delayed, weakness of the peroneii remained.
CONCLUSION
Early evacuation of hematoma achieved a more favorable result than a delayed operation. Early diagnosis and prompt surgical decompression is recommended to reduce neurologic sequelae.

Keyword

Early decompressive surgery; Compressive neuropathy; Hematoma

MeSH Terms

Decompression, Surgical
Early Diagnosis
Hematoma*
Humans
Retrospective Studies

Figure

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  Fig. 1. Removed Hemo-vac shows malfunction of suction lines due to occlusion by blood clot

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  Fig. 2. Immediate myelogram shows broad filling defect at main laminectomy site

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  Fig. 3. Abundant blood clots compressing dura were evacuated within 24 hours after initial decompressive surgery

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  Fig. 4. Right L5 & S1 roots were not visualized in myelogram performed on 11th postoperative day (white arrows)

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  Fig. 5. MRI performed on postoperative fourth month shows severe scar adhesion by granulation of hematoma at right L5 root (white arrow)

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