Consensus statement by the Belgian Society of Neurosurgery and literature review on the diagnosis and management of postoperative spinal epidural hematoma.

IF 1.9 Q3 CLINICAL NEUROLOGY Brain & spine Pub Date : 2024-09-11 eCollection Date: 2024-01-01 DOI:10.1016/j.bas.2024.103904
Steven Smeijers, Frederic Collignon, Emmanuel Costa, Kris Desmedt, Henri-Benjamin Pouleau, Nikolaas Vantomme, Bertrand Cailliau, Bart Depreitere, Dieter Peuskens
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Abstract

Introduction: Postoperative spinal epidural hematoma (SEH) is a potentially devastating complication for patients and caregivers, and a leading cause for litigation in spine surgery. This article provides a literature review and the consensus statement of the Belgian Society of Neurosurgery (BSN) on the management of postoperative SEH.

Research question: Can we implement current evidence to establish a framework on the management of postoperative SEH?

Material and methods: Based on a Pubmed search, abstracts were screened for topics covering incidence, pathophysiology, risk factors, surveillance, diagnosis, treatment, and outcome. Relevant topics are presented in a narrative review format, followed by a consensus statement of the BSN with emphasis on rapid diagnosis and treatment.

Results: Symptomatic SEH is rare (0.3-1%) and can have an insidious onset with rapid progression to neurological deficits. Recurring risk factors are coagulation deficiencies and multilevel surgery. The protective effect of a postoperative drainage system is uncertain, and early thrombo-embolic prophylaxis does not increase the risk of SEH. Prognosis is dependent on residual neurological function and critically, on the time to reintervention. There is a need for structured neurological observation formats after spine surgery.

Discussion and conclusion: Symptomatic SEH after surgery is an unpredictable and severe complication requiring rapid action to maximize outcomes. The BSN proposes three nuclear terms central to SEH management, converging on a triple 'S': 1) high level of suspicion 2) speed of diagnosis and 3) immediate surgery. All spine centers can benefit from an institutional protocol in which SEH should be treated as an emergency.

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比利时神经外科学会关于脊柱硬膜外血肿术后诊断和处理的共识声明和文献综述。
简介:术后脊柱硬膜外血肿(SEH)对患者和护理人员来说是一种潜在的破坏性并发症,也是脊柱手术诉讼的主要原因。本文提供了一篇文献综述和比利时神经外科学会(BSN)关于术后 SEH 管理的共识声明:研究问题:我们能否利用现有证据建立术后 SEH 的管理框架?根据 Pubmed 搜索结果,筛选了涉及发病率、病理生理学、风险因素、监测、诊断、治疗和结果等主题的摘要。相关主题以叙述性综述的形式呈现,随后是 BSN 的共识声明,重点是快速诊断和治疗:无症状的 SEH 非常罕见(0.3-1%),可隐匿起病,迅速发展为神经功能缺损。反复出现的危险因素是凝血功能障碍和多层次手术。术后引流系统的保护作用尚不确定,早期血栓栓塞预防并不会增加 SEH 的风险。预后取决于残存的神经功能,关键在于重新介入的时间。脊柱手术后需要结构化的神经系统观察模式:讨论和结论:术后出现症状性 SEH 是一种不可预测的严重并发症,需要迅速采取措施以最大限度地改善预后。BSN 提出了 SEH 管理的三个核心术语,汇聚成三个 "S":1)高度怀疑;2)快速诊断;3)立即手术。所有脊柱中心都能从将 SEH 作为急诊处理的机构协议中获益。
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来源期刊
Brain & spine
Brain & spine Surgery
CiteScore
1.10
自引率
0.00%
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0
审稿时长
71 days
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