Postoperative epidurale Hämatome: Verhinderung, Diagnostik und Therapie

Zusammenfassung

Das lumbale epidurale postoperative symptomatische Hämatom ist selten, mit einer Häufigkeit von 0.2 %. Als Risikofaktor für das Auftreten symptomatischer periduraler Hämatome werden aufwendige wirbelsäulenchirurgische Operationen, Alter der Patienten > 60 Jahren, perioperative Einnahme von NSAR, Verwendung von Antikoagulantien, sowie ein niedriges Hämoglobin < 10 mg/dL und eine niedrige Thrombozytenzahl erwähnt. Die typischen Symptome sind starke Rückenschmerzen, motorische Defizite oder eine Reithosenanästhesie. Bei Auftreten der Symptome ist ein zeitnahes MRT zur Diagnosesicherung zu veranlassen und die Ausdehnung des Hämatoms in kranio-kaudale Ausrichtung zu beschreiben. Die operative Intervention mit Hämatomausräumung, Spülung und Blutstillung hat innerhalb eines Zeitfensters von < 8 h eine gute Prognose.

Abstract

Epidural symptomatic postoperative hematoma is a rare complication with an incidence of 0.2 %. Enlarged surgical spine procedures, patient age > 60 years, the use of non steroid-inflammatories, anticoagulance, low platelet counts and hemoglobin < 10 mg/dL are identified as risk factors. Sudden severe back pain, loss of muscle strength or saddle anaesthesia are typical symptoms for epidural hematoma and a Magnetic resonance imaging shoud be arranged urgently. Once symptomatic epidural hematoma has been identified, the cranio-caudal extension of the hematoma should be established.

Surgical removal of organized blood clots, irrigation and stoppage of bleeding should be done in a time-frame of less than 8 hours for successful recovery.

Schlüsselwörter

epidurales Hämatom - Antikoagulanz - Blutstillung - neurolgische Defizite - dringliche operative Revision

Keywords

epidural hematoma - anticoagulants - stypsis - neurological deficit - emergent revision surgery

• Literatur

• 1 Boudissa M, Lebecque J, Boissière L. et al. Early reintervention after anterior cervical spine surgery. Epidemiology and risk factors: A case-control study. Orthop Traumatol Surg Res 2016; 102: 485-488
• 2 Schroeder GD, Kurd MF, Kepler CK. et al. Postoperative Epidural Hematomas in the Lumbar Spine. J Spinal Disord Tech 2015; 28: 313-318
• 3 Awad JN, Kebaish KM, Donigan J. et al. Analysis of risk factors for the development of postoperative spinal epidural haematoma. J Bone Joint Surg Br 2005; 87: 1248-1252
• 4 Mirzai H, Eminoglu M, Orguc S. Are drains useful for lumbar disc surgery? A prospective, randomized clinical study. J Spinal Disord Tech 2006; 19: 171-177
• 5 Kao FC, Tsai TT, Chen LH. et al. Symptomatic epidural hematoma after lumbar decompression surgery. Eur Spine J 2015; 24: 348-357
• 6 Domenicucci M, Mancarella C, Santoro G. et al. Spinal epidural hematoma: personal experience and literature review of more than 1000 cases. J Neurosurg Spine 2017; 27: 198-208
• 7 Ohba T, Ebata S, Haro H. Influence of postoperative hypertension on the development of spinal epidural hematoma. Orthop Surg 2017; 9: 386-390
• 8 Akhavan-Sigari R, Rohde V, Abili M. Continuation of medically necessary platelet aggregation inhibitors – acetylsalicylic acid and clopidogrel – during surgery for spinal degenerative disorders: Results in 100 Patients. Surg Neurol Int 2014; 5: S376-S379
• 9 Quante M, Zamani R, Simon MJK. et al. Thromboprophylaxis and platelet aggregation inhibitors in spinal surgery: perioperative management. Orthopade 2014; 43: 833-840
• 10 Uribe J, Moza K, Jimenez O. et al. Delaxed postoperative spinal epidural hematomas. Spine J 2003; 3: 125-129
• 11 Aano H, Ohwada T, Hosono N. et al. Incidence of postoperative symptomatic epidural hematoma in spinal decompression surgery. J Neurosurg Spine 2011; 15: 202-205
• 12 Radcliff KE, Morrison WB, Kepler C. et al. Distinguishing pseudomeningocele, epidural hematoma, and postoperative infection on postoperative MRI. J Spinal Disord Tech 2012; 25: 129-132
• 13 Mukerji N, Todd N. Spinal epidural haematoma; factors influencing outcome. Br J Neurosurg 2013; 27: 712-717
• 14 Bullmann V, Granitzka M. Blood management in complex reconstructive spine surgery in ASD patients: Do effective measures to reduce bleeding exists?. Orthopade 2018; 47: 296-300
• 15 Schroeder GD, Kurd MF, Kepler CK. et al. Postoperative Epidural Hematomas in the Lumbar Spine. J Spinal Disord Tech 2015; 28: 313-318