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Die Wirbelsäule 2019; 03(04): 255-259
DOI: 10.1055/a-0915-4577
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Postoperative epidurale Hämatome: Verhinderung, Diagnostik und Therapie

Postoperative epidural hematoma: prevention, diagnostics and therapy
Viola Bullmann
Klinik für Wirbelsäulenchirurgie/Orthopädie II, St. Franziskus-Hospital Köln
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
29. Oktober 2019 (online)

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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
 

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