Early diagnosis and treatment of early postoperative epidural hematoma after anterior cervical spine surgery

Objective To investigate the early diagnosis and treatment of early postoperative epidural hematoma after anterior cervical spine surgery. Methods There were 3 117 cases of anterior cervical spine surgery from June 1984 to May 2015. There were 7 cases of early onset of epidural hematoma, including 6 cases of ACCF, 3 cases of autogenous iliac bone graft, 3 cases of titanium mesh bone graft, and 1 cases of ACDF. We analyzed 7 cases of early postoperative epidural hematoma after anterior cervical ACDF and ACCF surgery in terms of age, height, weight, application of NSAIDs, the type of surgery, bleeding volume, measures of stopping bleeding, hematoma occurring time and time of removing hematoma. Surgical decision was made after MRI examination and clear evidence of clinical manifestations. Analysis of the re-operative cases was done. ASIA grading in hematoma causes was graded. The relations of the hematoma diagnosed time and classification of ASIA were studied. Relationships of confirmed time and operation time interval and ASIA grade of 1 year follow-up were studied. The spearman analysis was used. Results There were 7 cases of early postoperative epidural hematoma, accounting for 0.22% of the total cases. 6 cases of patients were in the age of more than 60 years old, accounting for 86%; 3 cases were more than 70 years old, accounting for 43%. 5 cases were obesity, accounting for 71%. There were 6 cases of ACCF in this group accounting for 86% of the cases of hematoma, which was 0.42% (6/1 416) of all ACCF cases. There was 1 case of ACDF accounting for 14% of the cases of hematoma, and 0.06% (1/1 573) cases of ACDF. Posterior longitudinal ligament were all removed in 7 cases in the first operation. The existence of hematoma was confirmed in 7 cases while 1 case's clinical symptoms was relieved after MRI examination and did not perform a second operation. The symptoms were improved for this case, and the ASIA level was E level in 1 year. 6 cases underwent immediate evacuation of hematoma, 5 cases had more than one ASIA grade improvement 1 year after operation. One case (14.3%) was grade D at the time of hematoma and at 1 year follow-up. Using Spearman, it can be concluded that there was no significant correlation between the time of diagnosis and the ASIA classification. The relationship of the interval time between diagnosis confirmed and operative time and ASIA grade of 1 year follow-up was analyzed using Spearman analysis. it can be concluded that the interval and ASIA grade at one year follow-up had no significant correlation. Conclusion Early onset epidural hematoma occurred in 6 to 8h after anterior cervical spine surgery. According to the specific clinical manifestations of early onset epidural hematoma and cervical MRI examination, we can make an early diagnose. For serious spinal cord compression, once the diagnosis is confirmed, early surgery of removing the hematoma is needed. Key words: Cervical vertebrae; Decompression, surgical; Spinal fusion; Hematoma, epidural, spinal; Early diagnosis