Consensus statement by the Belgian Society of Neurosurgery and literature review on the diagnosis and management of postoperative spinal epidural hematoma
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, surveillan... Mehr ...
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Dokumenttyp: | Artikel |
Erscheinungsdatum: | 2024 |
Reihe/Periodikum: | Brain and Spine, Vol 4, Iss , Pp 103904- (2024) |
Verlag/Hrsg.: |
Elsevier
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Schlagwörter: | Spinal epidural hematoma / Postoperative / Management / Complication / Spinal surgery / Neurology. Diseases of the nervous system / RC346-429 |
Sprache: | Englisch |
Permalink: | https://search.fid-benelux.de/Record/base-28886424 |
Datenquelle: | BASE; Originalkatalog |
Powered By: | BASE |
Link(s) : | https://doi.org/10.1016/j.bas.2024.103904 |
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.