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1.
Coluna/Columna ; 19(1): 71-74, Jan.-Mar. 2020. graf
Article in English | LILACS | ID: biblio-1089641

ABSTRACT

ABSTRACT The objective of this paper is to report a case of atypical evolution after a classic case of dengue confirmed by serology, in which the formation of an epidural hematoma with low back pain and radiculopathy was observed. The article is a qualitative and descriptive case report. Data were collected from the medical records of the hospital where the patient was treated. In conclusion, the diagnostic correlation of dengue with this rare condition was possible due to radiological comparisons before and after the formation of the extradural hematoma. Level of evidence V; Expert Opinion.


RESUMO O presente trabalho tem como objetivo relatar um caso de evolução atípica após quadro clássico de dengue, confirmada por sorologia, em que foi observada a formação de um hematoma extradural, com dor lombar baixa e radiculopatia. O artigo é tipo relato de caso, qualitativo e descritivo. Os dados foram coletados no prontuário do hospital onde o doente foi atendido. Como conclusão, a correlação diagnóstica da dengue com essa afecção rara foi possível devido a comparações radiológicas pré- e pós-formação do hematoma extradural. Nível de evidência V; Opinião de Especialista.


RESUMEN El presente trabajo tiene como objetivo relatar un caso de evolución atípica después de un cuadro clásico de dengue, confirmado por serología, en el que se observó la formación de un hematoma extradural, con dolor lumbar bajo y radiculopatía. El artículo es tipo relato de caso, cualitativo y descriptivo. Los datos fueron recolectados en el prontuario del hospital en donde el enfermo fue atendido. Como conclusión, la correlación diagnóstica del dengue con esta afección fue posible debido a las comparaciones radiológicas pre y post formación del hematoma extradural. Nivel de evidencia V; Opinión de Especialista.


Subject(s)
Humans , Dengue , Hematoma, Epidural, Spinal , Lumbosacral Region
2.
Rev. Asoc. Argent. Ortop. Traumatol ; 84(3): 260-264, jun. 2019. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1020341

ABSTRACT

El hematoma epidural espontáneo es una entidad muy poco frecuente que supone una urgencia neurológica. Su presentación es muy variable, desde un dolor de espalda hasta una tetraplejia, según la gravedad y el nivel de compresión. Se comunica el caso de un paciente cardiópata de 71 años, tratado con acenocumarol, que presentó un hematoma epidural de modo espontáneo. Al inclinarse hacia el suelo, el paciente, que no tenía síntomas, sufrió un dolor brusco cervical seguido de debilidad en los miembros superiores e inferiores. Ante la sospecha clínica de una compresión medular, se decide realizar una resonancia magnética de urgencia, que mostró un hematoma de localización epidural con extensión desde C4 hasta T8. El diagnóstico urgente y el tratamiento de descompresión precoz son fundamentales para reducir al mínimo los daños neurológicos posteriores permanentes. Nivel de Evidencia: IV


Spontaneous spinal epidural hematoma is an uncommon condition and a neurological emergency. The clinical presentation of this type of hematoma is very variable, ranging from a backache up to a quadriplegia, according to the severity and the site of compression. Here, we discuss the clinical case of a 71-year-old patient with heart problems, under previous treatment with acenocumarol, that suffered a spontaneous epidural hematoma. The patient, previously asymptomatic, presented, sudden cervical pain when he bent over, followed by weakness in the lower and the upper limbs. Due to the clinical suspicion, an emergency MRI was performed, showing an epidural hematoma extending from C4 to T8. Early diagnosis and decompressive treatment are mandatory to minimize permanent neurological damage. Level of Evidence: IV


Subject(s)
Aged , Spinal Diseases , Decompression, Surgical/methods , Hematoma, Epidural, Spinal/surgery , Emergency Treatment , Acenocoumarol/adverse effects
3.
Article in Korean | WPRIM | ID: wpr-770040

ABSTRACT

Spinal epidural hematoma (SEH) can occur naturally or traumatically and is most common in patients with an underlying disease of the vascular structure or coagulation disorder. Most SEHs occur naturally for no apparent reason, and epidural hematoma caused by trauma is less common, comprising 1.0%–1.7% of total spinal injuries. Few reports of SEH induced cauda equine syndrome resulting from low-energy injury caused by osteoporotic vertebral compression fractures are available. The authors experienced a case of delayed SEH after hemorrhage due to a low-energy injury in an elderly patient. No cases in Korea have been reported; therefore, this case is reported with a review of the relevant literature.


Subject(s)
Aged , Allografts , Arthroplasty , Fractures, Compression , Hematoma , Hematoma, Epidural, Spinal , Hemorrhage , Humans , Humerus , Korea , Spinal Injuries
4.
Article in English | WPRIM | ID: wpr-719396

ABSTRACT

BACKGROUND: The clinical outcomes and safety of thoracic epidural catheterization in anesthetized adult patients has not yet been established. The purpose of this study was to compare clinical differences between epidural catheterization performed before and after anesthesia for postoperative pain control. METHODS: The medical records of 549 patients who received thoracic epidural catheterization before (awake group, n = 303) or after (anesthetized group, n = 246) induction of anesthesia for major abdominal surgery were reviewed retrospectively. RESULTS: The catheter insertion time (1.6 ± 1.5 vs. 1.1 ± 1.2 min; 95% confidence interval [95% CI], 0.3–0.8; effect size, 0.368; P < 0.001) and number of attempts required for successful epidural catheterization (1 [1, 3] vs. 1 [1, 2], P = 0.003) were increased in the awake group. The incidence rates of dural puncture, vascular injury and postoperative paresthesia were similar between the two groups. The median surgical site numerical rating scale pain score (0 = no pain, 10 = worst pain imaginable) was lower in the awake group than in the anesthetized group (3 vs. 4 on postoperative day 1, P < 0.001; and 2 vs. 3 on postoperative day 3, P = 0.002). Serious complications, including meningitis, epidural abscess, epidural hematoma, spinal cord injury, and paraplegia, were not observed in either group. CONCLUSIONS: Successful epidural catheterization before induction of anesthesia required more attempts versus after anesthesia. Overall complication rates of thoracic epidural catheterization were similar regardless of the timing of the procedure.


Subject(s)
Adult , Analgesia, Epidural , Anesthesia , Catheterization , Catheters , Epidural Abscess , Hematoma, Epidural, Spinal , Humans , Incidence , Medical Records , Meningitis , Pain, Postoperative , Paraplegia , Paresthesia , Postoperative Complications , Punctures , Retrospective Studies , Vascular System Injuries
5.
Article in English | WPRIM | ID: wpr-719395

ABSTRACT

Rivaroxaban, a factor Xa inhibitor, is one of the newly developed direct oral anticoagulants (DOAC). In recent times, it has been increasingly used in the prevention of pulmonary embolism in patients undergoing orthopedic surgery. This report describes a case of epidural hematoma in an elderly patient who underwent combined spinal epidural anesthesia for total knee arthroplasty; the patient received rivaroxaban postoperatively for 7 days to prevent pulmonary embolism. Additionally, the epidural hematomas developed on the 5th postoperative day but the patient recovered well with conservative treatment. Although rivaroxaban has a low need for monitoring and is easily administered, the guidelines should be carefully checked for the postoperative administration schedule in patients undergoing regional anesthesia. In addition, rivaroxaban should be used with caution, especially in elderly patients.


Subject(s)
Aged , Anesthesia, Conduction , Anesthesia, Epidural , Anticoagulants , Appointments and Schedules , Arthroplasty, Replacement, Knee , Factor Xa , Hematoma , Hematoma, Epidural, Spinal , Humans , Orthopedics , Pulmonary Embolism , Rivaroxaban
6.
Article in Korean | WPRIM | ID: wpr-765634

ABSTRACT

STUDY DESIGN: Case report. OBJECTIVES: We report a case of recurrent spinal epidural hematoma after total spondylectomy for a metastatic spinal tumor. SUMMARY OF LITERATURE REVIEW: Postoperative epidural hematoma is rare, and no case of delayed epidural hematoma after hematoma removal has been reported. MATERIALS AND METHODS: A 74-year-old woman experienced a ninth thoracic vertebral (T9) pathologic fracture caused by a metastatic spinal tumor and underwent total spondylectomy. Immediate postoperative epidural hematoma occurred and neurological symptoms appeared. After hematoma removal, the symptom improved. Ten days after surgery, the neurological symptoms worsened again. Spine magnetic resonance imaging showed delayed epidural hematoma. Hematoma removal was done again. RESULTS: The patient's neurological symptoms improved after delayed hematoma removal. CONCLUSIONS: Delayed hematoma that cause neurological symptoms may occur after primary hematoma removal. If neurological symptoms recur after hematoma removal, the surgeon should consider the possibility of hematoma recurrence. Before total spondylectomy surgery, preoperative embolization is recommended.


Subject(s)
Aged , Female , Fractures, Spontaneous , Hematoma , Hematoma, Epidural, Spinal , Humans , Magnetic Resonance Imaging , Recurrence , Spine
7.
Article in English | WPRIM | ID: wpr-758900

ABSTRACT

The magnetic resonance (MR) features of spinal epidural hemorrhage depending with the passage of time have a meaning in veterinary medicine. The aim of this study is to propose the characteristic MR image of spinal epidural hemorrhage using a lower field permanent magnet scanner in dogs. A total of 8 clinically normal beagle dogs, weighing about 9 kg, were allocated. After a baseline MR examination, spinal epidural hemorrhage was created. MR scanning was executed on days 1, 2, 3, 4, 5, 10, 15, 20, 25, and 30 using 0.25 Tesla low field MR. Transverse MR images were attained for image examination. T2W, T1W, fluid-attenuated inversion recovery (FLAIR), short tau inversion recovery (STIR), and T2*-GRE sequences were used. Images were compared subjectively for signal transition assessment. Spinal epidural hemorrhage models were produced positively in 8 dogs at the T12 to L2 region. Initially, the spinal cord and epidural lesions were hyper-intense on T2W and T1W images. On T2W, FLAIR and STIR images, the spinal cord lesion was steadily hyperintense. No significant and consistent hypointense signal indicating hemorrhage was seen on T2*-GRE images. This study result suggests that relatively consistent hyperinstensity on T2 and FLAIR is observed for 30 days, meanwhile T2*-GRE imaging is less useful in hemorrhage detection.


Subject(s)
Animals , Dogs , Hematoma, Epidural, Spinal , Hemorrhage , Spinal Cord , Veterinary Medicine
8.
Article in Korean | WPRIM | ID: wpr-717636

ABSTRACT

Spinal epidural hematoma (SEH) is a rare neurosurgical emergency in which pressure on the spinal cord leads to acute neurological deficits, and is a rare complication in children with hemophilia. We report three cases of SEH in severe hemophilia A. An 8-month-old boy who presented with non-traumatic acute-onset irritability was found to have SEH and was later diagnosed with hemophilia. The two other patients presented with neck pain and magnetic resonance imaging confirmed the diagnosis of SEH. Two patients who received conservative management fully recovered, however the patient who presented with progressive neurological abnormalities at the time of diagnosis, received surgery but later developed breathing difficulties and quadriplegia. Early diagnosis and immediate, aggressive, clotting factor replacement therapy are crucial when managing SEH in children with hemophilia. Immediate and aggressive factor replacement, accompanied by both neurological monitoring and early imaging, are essential for hemophiliac with suspected SEH.


Subject(s)
Child , Diagnosis , Early Diagnosis , Emergencies , Hematoma , Hematoma, Epidural, Spinal , Hemophilia A , Humans , Infant , Magnetic Resonance Imaging , Male , Neck Pain , Quadriplegia , Respiration , Spinal Cord
9.
Article in English | WPRIM | ID: wpr-716623

ABSTRACT

BACKGROUND: The incidence of cardiovascular and neurovascular diseases has been increasing with the aging of the population, and antiplatelet drugs (APDs) are more frequently used than in the past. With the average age of spinal surgery patients also increasing, there has been a great concern on the adverse effects of APD on spine surgery. To our knowledge, though there have been many studies on this issue, their results are conflicting. In this study, we aimed to determine the influence of APDs on spine surgery in terms of intraoperative bleeding and postoperative spinal epidural hematoma complication. METHODS: Patients who underwent posterior thoracolumbar decompression and instrumentation at our institution were reviewed. There were 34 APD takers (APDT group). Seventy-nine non-APD takers (NAPDT group) were selected as a control group in consideration of demographic and surgical factors. There were two primary endpoints of this study: the amount of bleeding per 10 minutes and cauda equina compression by epidural hematoma measured at the cross-sectional area of the thecal sac in the maximal compression site on the axial T2 magnetic resonance imaging scans taken on day 7. RESULTS: Both groups were homogeneous regarding age and sex (demographic factors), the number of fused segments, operation time, and primary/revision operation (surgical factors), and the number of platelets, prothrombin time, and activated partial thromboplastin time (coagulation-related factors). However, the platelet function analysis-epinephrine was delayed in the APDT group than in the NAPDT group (203.6 seconds vs. 170.0 seconds, p = 0.050). Intraoperative bleeding per 10 minutes was 40.6 ± 12.8 mL in the APDT group and 43.9 ± 9.9 mL in the NAPDT group, showing no significant difference between the two groups (p = 0.154). The cross-sectional area of the thecal sac at the maximal compression site by epidural hematoma was 120.2 ± 48.2 mm2 in the APDT group and 123.2 ± 50.4 mm2 in the NAPDT group, showing no significant difference between the two groups (p = 0.766). CONCLUSIONS: APD medication did not increase intraoperative bleeding and postoperative spinal epidural hematoma. Therefore, it would be safer to perform spinal surgery without discontinuation of APD therapy in patients who are vulnerable to cardiovascular and neurovascular complications.


Subject(s)
Aging , Blood Platelets , Cauda Equina , Decompression , Hematoma , Hematoma, Epidural, Spinal , Hemorrhage , Humans , Incidence , Magnetic Resonance Imaging , Partial Thromboplastin Time , Platelet Aggregation Inhibitors , Prothrombin Time , Spine
10.
Article in English | WPRIM | ID: wpr-713926

ABSTRACT

OBJECTIVE: Acute hemiparesis is often an early presentation of acute ischemic stroke, though it can occur in various disorders. This study aimed to investigate the improper use of thrombolytic agents for patients with acute hemiparesis, following the misdiagnosis of acute ischemic stroke. METHODS: We analyzed the clinical and radiological data of nine patients initially misdiagnosed with cerebral stroke in the emergency room from May 2013 to January 2017. All the patients were treated with tissue plasminogen activator (TPA) owing to the presence of acute hemiparesis. Subsequently, emergent computed tomography scan showed no intracranial hemorrhage. Clinical findings including neurological deficits, clinical course, and related complications were detected and analyzed. RESULTS: Acute hemiparesis was observed in the following conditions: spontaneous spinal epidural hematoma, Brown-Séquard syndrome caused by cervical disc herniation, cervical epidural abscess, hypoglycemia in the presence of an old stroke, and seizure or convulsion disorder. Although acute hemiparesis was regarded as a contraindication, inappropriate TPA administration did not aggravate the neurological condition in any of the patients who required surgery. CONCLUSION: Upon presentation of acute hemiparesis, various conditions mimicking cerebral stroke should be considered to avoid misdiagnosis. We suggest that physicians should exercise caution when prescribing thrombolytic agents.


Subject(s)
Diagnostic Errors , Emergency Service, Hospital , Epidural Abscess , Fibrinolytic Agents , Hematoma, Epidural, Spinal , Humans , Hypoglycemia , Intracranial Hemorrhages , Paresis , Seizures , Stroke , Tissue Plasminogen Activator
11.
Article in Korean | WPRIM | ID: wpr-713754

ABSTRACT

Hemophilia is a disease that causes a hemorrhagic tendency due to a congenital deficiency of blood clotting factors. Hemorrhagic arthritis is the most common complication in hemophilia patients, and hemorrhage in various areas, such as intramuscular hemorrhage and mucosal hemorrhage, can occur. Among the most dangerous complications, central nervous system hemorrhage can occur, which is the most common cause of death in hemophiliacs. An intracerebral hemorrhage in a central nervous system hemorrhage is very rare but occurs spontaneously, and it is often traumatic. Some cases have been reported in foreign countries, but there are no cases reported in Korea. Most cases reported in foreign countries occurred in the cervical to the thoracic regions, but there are no cases in only the cervical region. This paper reports a case of spinal epidural hematoma that developed spontaneously in a child with hemophilia complaining of neck pain.


Subject(s)
Arthritis , Blood Coagulation , Cause of Death , Central Nervous System , Cerebral Hemorrhage , Child , Hematoma, Epidural, Spinal , Hemophilia A , Hemorrhage , Humans , Korea , Neck Pain , Neck , Pediatrics
12.
Korean Journal of Spine ; : 96-98, 2017.
Article in English | WPRIM | ID: wpr-187208

ABSTRACT

Although the etiology of spontaneous spinal epidural hematoma (SSEH) is unclear, SSEH is known to be associated with anticoagulants, coagulopathy, vascular malformation, hypertension, and pregnancy. However, no report has been issued on the relation between SSEH and venous phlebolith. Here, the authors present an extremely rare case of SSEH associated with phlebolith in the cervical spine and suggest a possible pathogenesis. A 36-year-old man without any relevant medical history presented with neck pain and numbness and severe radiating pain on the left arm. Magnetic resonance imaging showed epidural hematoma at the C5–7 level, and computed tomography revealed a calcified nodule in the left epidural hemorrhage at C6 level. During left partial laminectomy, epidural venous plexus, and thick epidural hematoma were found, and hematoma removal revealed a white, ovoid, smooth, hard mass of diameter 3 mm. Histopathologic examination confirmed the mass as a venous phlebolith. The presence of a calcified solitary nodule in dorsal epidural space indicates the presence of phlebolith and the risk of SSEH. In such cases, the authors recommend spine surgeons should take into consideration the possibility of epidural hemorrhage.


Subject(s)
Adult , Anticoagulants , Arm , Epidural Space , Hematoma , Hematoma, Epidural, Spinal , Hemorrhage , Humans , Hypertension , Hypesthesia , Laminectomy , Magnetic Resonance Imaging , Neck Pain , Pregnancy , Spine , Surgeons , Vascular Malformations
13.
Article in English | WPRIM | ID: wpr-202491

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.


Subject(s)
Decompression , Decompression, Surgical , Hematoma , Hematoma, Epidural, Spinal , Humans , Magnetic Resonance Imaging , Platelet Count , Postoperative Care , Postoperative Complications , Prognosis , Prothrombin Time , Retrospective Studies , Spinal Cord , Spine , Suction , Visual Analog Scale
14.
Asian Spine Journal ; : 898-902, 2017.
Article in English | WPRIM | ID: wpr-102659

ABSTRACT

STUDY DESIGN: Retrospective case-control study. PURPOSE: To examine the hypothesis that the misuse of thrombin-containing local hemostatics (TCLH) increases the risk of postoperative spinal epidural hematoma (POSEH). OVERVIEW OF LITERATURE: Many studies have focused on hypocoagulability as a risk factor for POSEH. However, there are no prior reports on the increased risk of POSEH in hypercoagulable states. METHODS: Posterior instrumented lumbar spine surgery cases over 2 consecutive years were divided into two groups: a study group (98 patients in whom TCLH was used) and a control group (176 patients in whom TCLH was not used). The excess TCLH matrix that was not associated with blood clot was not removed from the patients in the study group. The senior author decided whether to use TCLH or not. Suction drains were used in all patients. The demographics, coagulation-related factors, and intraoperative factors of the patients in the two groups were analyzed. The development of POSEH was compared between the two groups. RESULTS: The two groups were homogenous in demographics (age and sex), coagulation-related factors (platelet count, prothrombin time, activated partial thromboplastin time, and platelet function analysis), and surgical factors (total blood loss, operation time, blood loss/10 minutes, number of fusion segments, posterolateral fusion/posterior lumbar interbody fusion, and virgin or revision surgery). POSEH developed more frequently in the patients in the study group than in those in the control group (14/98 patients, 14.3% vs. 3/176 patients, 1.7%, respectively; p=0.001; odds ratio, 17.1). CONCLUSIONS: TCLH causes blood clot not only at the edge of damaged vessels but also at the site of extravascular blood. Excess TCLH matrix not associated with blood clot at the epidural space can enhance POSEH development because early clotted hematomas do not drain through suction drains.


Subject(s)
Blood Platelets , Case-Control Studies , Demography , Epidural Space , Hematoma , Hematoma, Epidural, Spinal , Hemostatics , Humans , Odds Ratio , Partial Thromboplastin Time , Prothrombin Time , Retrospective Studies , Risk Factors , Spine , Suction
15.
Article in English | WPRIM | ID: wpr-145719

ABSTRACT

Epidural hematoma after epidural block is a rare complication in healthy patients without risk factor. However, this rare disease can lead to neurological symptoms or paralysis. It is usually treated with surgical drainage. Herein we report a case of acute thoracic epidural hematoma associated with neurologic symptoms after epidural block in a healthy male without risk factors. We performed drainage of the epidural hematoma using 18-gauge Tuohy needle without surgical intervention. The patient's neurological symptoms and pain were relieved. He was discharged without sequelae.


Subject(s)
Drainage , Hematoma , Hematoma, Epidural, Spinal , Humans , Male , Needles , Neurologic Manifestations , Paralysis , Rare Diseases , Risk Factors , Spine
16.
Neurology Asia ; : 287-290, 2016.
Article in English | WPRIM | ID: wpr-625394

ABSTRACT

Cervical spinal manipulation is considered to be a safe procedure for treating patients with neck pain and muscle-tension headache. Rarely has acute cervical spinal epidural hematoma after spinal manipulation been reported. Here, we report a 16-year-old healthy male adolescent who presented with progressive weakness in the right extremities following acute neck and shoulder pain after spinal manipulation from Acute cervical spinal epidural hematoma with compression of spinal cord. After emergency surgery the patient had full recovery from the profound neurological deficits.


Subject(s)
Hematoma, Epidural, Spinal
17.
Article in English | WPRIM | ID: wpr-215538

ABSTRACT

BACKGROUND: Postoperative spinal epidural hematoma (POSEH) is different from spontaneous or post-spinal procedure hematoma because of the application of suction drains. However, it appeared that suction drains were not effective for prevention of POSEH in previous studies. The purpose of this study was to test our hypothesis that POSEH can be caused by hypercoagulability. METHODS: This was an experimental study. One hundred fifty milliliters of blood was donated from each of the 12 consecutive patients who underwent spine surgery and infused into 3 saline bags of 50 mL each. One of the 3 bags in each set contained 5,000 units of thrombin. All of them were connected to 120 ± 30 mmHg vacuum suctions: drainage was started 8 minutes after connection to the vacuum system for 12 normal blood bags (BV8) and 12 thrombin-containing blood bags (TBV8) and 15 minutes after connection for the remaining 12 normal blood bags (BV15). The amount of initial and remaining hematoma at 20 minutes, 120 minutes, and 24 hours after vacuum application were measured by their weight (g). The primary endpoint was the difference between BV8 and TBV8. The secondary end point was the difference between BV8 and BV15. RESULTS: The remaining hematoma in TBV8 was significantly greater than that in BV8 at all measurement points: 46.3 ± 12.4 vs. 17.0 ± 1.3 (p = 0.000) at 20 minutes; 33.0 ± 8.2 vs. 16.3 ± 1.2 (p = 0.000) at 120 minutes; and 26.1 ± 4.0 vs. 15.8 ± 1.6 (p = 0.000) at 24 hours after vacuum application. The remaining hematoma of BV15 was significantly greater than that of BV8 at all measurement points: 30.0 ± 12.0 vs. 17.0 ± 1.3 (p = 0.002) at 20 minutes; 24.2 ± 7.6 vs. 16.3 ± 1.2 at 120 minutes (p = 0.002); and 22.2 ± 6.6 vs. 15.8 ± 1.6 (p = 0.004) at 24 hours after vacuum application. CONCLUSIONS: With a suction drain in place, the amount of remaining hematoma could be affected by coagulability. Thrombin-containing local hemostatics and the length of time elapsed before the commencement of suction resulted in hypercoagulability, indicating these two factors could be causes of POSEH.


Subject(s)
Drainage , Hematoma , Hematoma, Epidural, Spinal , Hemostatics , Humans , Spine , Suction , Thrombin , Thrombophilia , Vacuum
18.
Article in English | WPRIM | ID: wpr-101611

ABSTRACT

BACKGROUND: Epidural hematoma is a rare but serious complication. According to previous studies, it is not prevented by suction drains. This study evaluated the following alternative hypothesis: the larger the diameter of a suction drain, the less the remaining epidural hematoma after spinal surgery. METHODS: This was a randomized prospective study. Patients who underwent posterior lumbar decompression and instrumented fusion were divided into two groups: the large drain (LD, 2.8-mm-diameter tube) and small drain (SD, 1.6-mm-diameter tube) groups according to the diameter of the suction drains. All patients were consecutive and allocated alternately according to the date of operations. Suction drains were removed on day 3 and magnetic resonance imaging was performed on day 7 postoperatively. The size of remaining hematomas was measured by the degree of thecal sac compression in cross section using the following 4-point numeric scale: G1, less than one quarter; G2, between one quarter and half; G3, more than half; and G4, more than subtotal obstruction. RESULTS: There were 39 patients with LDs and 38 with SDs. They did not differ significantly in terms of sex, number of fusion segments, revision or not, antiplatelet medication, intraoperative injection of tranexamic acid. However, patient age differed significantly between the two groups (LD, 63.3 years and < SD, 68.6 years; p = 0.007). The two groups did not differ significantly in terms of prothrombin time, activated partial thromboplastin time, platelet number, blood loss, or operation duration. However, platelet function analysis exhibited a significant difference (LD, 164.7 seconds and < SD, 222.3 seconds; p = 0.002). The two blinded readers showed high consistency (Kappa value = 0.740; p = 0.000). The results of reader 1 were as follows: LD and SD had 21 and 21 cases of G1, 9 and 11 cases of G2, 6 and 6 cases of G3, and 3 and 0 cases of G4, respectively. The results of reader 2 were as follows: LD and SD had 22 and 23 cases of G1, 7 and 9 cases of G2, 7 and 6 cases of G3, and 3 and 0 cases of G4, respectively. There was no difference between the two groups (reader 1, p = 0.636; reader 2, p = 0.466). CONCLUSIONS: The alternative hypothesis was rejected. Therefore, postoperative spinal epidural hematoma would not be prevented by LD.


Subject(s)
Aged , Equipment Design , Female , Hematoma, Epidural, Spinal/epidemiology , Humans , Male , Middle Aged , Postoperative Complications/epidemiology , Prospective Studies , Spine/surgery , Suction/adverse effects
19.
Korean Journal of Spine ; : 167-169, 2016.
Article in English | WPRIM | ID: wpr-42836

ABSTRACT

Spontaneous spinal epidural hematoma (SSEH) has been reported as a rare cause of spinal cord compression, especially in children. Clinical features are usually nonspecific, although cervicothoracic location of hematoma could be presented with progressive paraplegia. Guillian-Barré syndrome (GBS) is clinically defined as an acute peripheral neuropathy causing progressive limb weakness. Because SSEH and GBS have very similar signs and symptoms, SSEH could be misdiagnosed as GBS. Nevertheless, they can be presented together. We describe a rare case of SSEH coexisting with GBS.


Subject(s)
Child , Extremities , Guillain-Barre Syndrome , Hematoma , Hematoma, Epidural, Spinal , Humans , Paraplegia , Pediatrics , Peripheral Nervous System Diseases , Spinal Cord Compression
20.
Article in English | WPRIM | ID: wpr-82808

ABSTRACT

Short inversion time inversion recovery (STIR) is widely used for spinal magnetic resonance imaging (MRI) because the pulse sequence of STIR is insensitive to magnetic field inhomogeneity and can be used to scan a large field of view. In this case report, we present a case of spinal epidural hematoma with unexpected signal decrease on a STIR image. The MRI showed an epidural mass that appeared with high signal intensity on both T1- and T2-weighted images. However, a signal decrease was encountered on the STIR image. This nonspecific decrease of signal in tissue with a short T1 relaxation time that is similar to that of fat (i.e., hemorrhage) could lead to a diagnostic pitfall; one could falsely diagnose this decrease of signal as fat instead of hemorrhage. Awareness of the nonselective signal suppression achieved with STIR pulse sequences may avert an erroneous diagnosis in image interpretation.


Subject(s)
Diagnosis , Hematoma, Epidural, Spinal , Hemorrhage , Magnetic Fields , Magnetic Resonance Imaging , Relaxation , Spine
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