Clin Orthop Surg.  2017 Jun;9(2):184-189. 10.4055/cios.2017.9.2.184.

Should We Check the Routine Postoperative MRI for Hematoma in Spinal Decompression Surgery?

• Shin HK
• Jeong HJ
• Kim E
• Park JH
• Park SJ
• Cho Y

• KMID: 2412286
• DOI: http://doi.org/10.4055/cios.2017.9.2.184

Abstract

BACKGROUND
A postoperative magnetic resonance imaging (MRI) is performed as a routine to assess decompression of the spinal cord as well as to evaluate postoperative complications. The purpose of this study is to analyze the efficacy of postoperative MRI for hematoma in spinal decompression surgery.
METHODS
Between January 1, 2008 and January 31, 2015, 185 patients who underwent postoperative MRI after spinal decompression surgery were included in this study. We checked the history of the use of an anticoagulant or antiplatelet agent, withdrawal period, blood platelet count, and prothrombin time (international normalized ratio [INR]). We measured the total amount of suction drainage and duration until removal. We retrospectively reviewed the presence of hematoma and thecal sac compression. Postoperative prognosis was evaluated by a visual analog scale (VAS) and the Oswestry Disability Index (ODI).
RESULTS
Hematomas were found on postoperative MRI scans in 97 out of 185 patients (52.4%). Thirty patients had a thecal sac compressing hematoma: 7 in the cervical spine, 1 in the thoracic spine, and 22 in the lumbar spine. The occurrence of hematoma did not show significant difference according to the use of an anticoagulant (p = 0.157). The blood platelet count, prothrombin time (INR), and suction drainage duration did not have a statistically significant correlation with the occurrence of hematoma (p = 0.562, p = 0.506, and p = 0.429, respectively). The total amount of suction drainage was significantly different according to the presence of hematoma (p = 0.022). The total 185 patients had a significant decrease in the postoperative VAS score (p < 0.001), and the diminution of VAS score was not significantly different according to the occurrence of hematoma (p = 0.243). Even in the cases of thecal sac compressing hematoma, the reduction of VAS score was not significantly different (p = 0.689).
CONCLUSIONS
Postoperative MRI for hematoma in spinal decompression surgery has little effect on prognosis or management. Therefore, indiscriminate postoperative MRI should be avoided and MRI should be performed depending on the patient's status.

Keyword

Spinal epidural hematoma; Surgical decompression; Magnetic resonance imaging; Postoperative care

MeSH Terms

Aged
*Decompression, Surgical/adverse effects/statistics & numerical data
Female
Hematoma, Epidural, Spinal/*diagnostic imaging
Humans
*Magnetic Resonance Imaging
Male
Middle Aged
Postoperative Care
Postoperative Complications/*diagnostic imaging
Retrospective Studies

Figure

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  Fig. 1 (A) T2-weighted sagittal magnetic resonance imaging (MRI). Note the epidural hematoma at L5 level. (B) T2-weighted axial MRI. Note the pedicle screws and the epidural hematoma compressing the thecal sac and the nerve root.

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