Epidural Hematoma Following Cervical Spine Surgery.

Study Design: A multicentered retrospective case series.
Objective: To determine the incidence and circumstances surrounding the development of a symptomatic postoperative epidural hematoma in the cervical spine.
Methods: Patients who underwent cervical spine surgery between January 1, 2005, and December 31, 2011, at 23 institutions were reviewed, and all patients who developed an epidural hematoma were identified.
Results: A total of 16 582 cervical spine surgeries were identified, and 15 patients developed a postoperative epidural hematoma, for a total incidence of 0.090%. Substantial variation between institutions was noted, with 11 sites reporting no epidural hematomas, and 1 site reporting an incidence of 0.76%. All patients initially presented with a neurologic deficit. Nine patients had complete resolution of the neurologic deficit after hematoma evacuation; however 2 of the 3 patients (66%) who had a delay in the diagnosis of the epidural hematoma had residual neurologic deficits compared to only 4 of the 12 patients (33%) who had no delay in the diagnosis or treatment ( P = .53). Additionally, the patients who experienced a postoperative epidural hematoma did not experience any significant improvement in health-related quality-of-life metrics as a result of the index procedure at final follow-up evaluation.
Conclusion: This is the largest series to date to analyze the incidence of an epidural hematoma following cervical spine surgery, and this study suggest that an epidural hematoma occurs in approximately 1 out of 1000 cervical spine surgeries. Prompt diagnosis and treatment may improve the chance of making a complete neurologic recovery, but patients who develop this complication do not show improvements in the health-related quality-of-life measurements.
Competing Interests: Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Gregory D. Schroeder reports grants from AOSpine North America during the conduct of the study, other from AOSpine, grants from Medtronic, outside the submitted work; Alan S. Hilibrand reports grants from AOSpine North America during the conduct of the study, other from Amedica, Vertiflex, Benvenue, Lifespine, Paradigm Spine, PSD, Spinal Ventures, outside the submitted work, and in addition, Dr. Hilibrand has a patent Aesculap, Amedica, Biomet, Stryker, Alphatec, with royalties paid; David E. Fish reports grants from AOSpine North America during the conduct of the study; Jeffrey C. Wang reports grants from AOSpine North America during the conduct of the study; Jeffrey L. Gum reports grants from AOSpine North America during the conduct of the study, personal fees from Medtronic, Alphatec, Stryker, LifeSpine, Acuity, Pacira, PAKmed, Gerson Lehrman Group, personal fees from OREF, AOSpine, personal fees from Acuity, other from Medtronic, personal fees from MiMedx, Pacira Pharmaceuticals, Alphatec, grants from Fischer Owen Fund, nonfinancial support from American Journal of Orthopaedics, nonfinancial support from American Journal of Orthopaedics, The Spine Journal, outside the submitted work; Zachary A. Smith reports grants from AOSpine North America during the conduct of the study; Wellington K. Hsu reports grants from AOSpine North America during the conduct of the study, personal fees from Medtronic, personal fees from Stryker, personal fees from Bacterin, personal fees from Graftys, personal fees from Ceramtec, personal fees from Relievant, personal fees from Bioventus, personal fees from Globus, personal fees from SpineSmith, outside the submitted work; Ziya L. Gokaslan reports grants from AOSpine North America during the conduct of the study, grants from AOSpine North America, personal fees from AO Foundation, grants from AOSpine, outside the submitted work; Robert E. Isaacs reports grants from AOSpine North America during the conduct of the study, grants and personal fees from NuVasive, Inc., personal fees from Association for Collaborative Spine research, outside the submitted work; Thomas E. Mroz reports other from AOSpine, grants from AOSpine North America during the conduct of the study; personal fees from Stryker, personal fees from Ceramtec, other from Pearl Diver, outside the submitted work; Ahmad Nassr reports grants from AOSpine North America during the conduct of the study; Michael G. Fehlings reports grants from AOSpine North America during the conduct of the study; Zorica Buser reports grants from AOSpine North America during the conduct of the study; Peter I. Cha reports grants from AOSpine North America during the conduct of the study; Erica L. Gee reports grants from AOSpine North America during the conduct of the study; Elizabeth L. Lord reports grants from AOSpine North America during the conduct of the study; Erik N. Mayer reports grants from AOSpine North America during the conduct of the study; Owen J. McBride reports grants from AOSpine North America during the conduct of the study; Emily C. Nguyen reports grants from AOSpine North America during the conduct of the study; P. Justin Tortolani reports grants from AOSpine North America during the conduct of the study, other from Globus Medical, grants from Spineology, other from Innovasis, outside the submitted work, and in addition, Dr. Tortolani has a patent Globus with royalties paid; D. Alex Stroh reports grants from AOSpine North America, during the conduct of the study; and K. Daniel Riew reports personal fees from AOSpine International, other from Global Spine Journal, other from Spine Journal, other from Neurosurgery, personal fees from Multiple Entities for defense, plantiff, grants from AOSpine, grants from Cerapedics, grants from Medtronic, personal fees from AOSpine, personal fees from NASS, personal fees from Biomet, personal fees from Medtronic, nonfinancial support from Broadwater, outside the submitted work; Paul M. Arnold reports grants from AOSpine North America during the conduct of the study; other from Z-Plasty, other from Medtronic Sofamore Danek, other from Stryker Spine, other from FzioMed, other from AOSpine North America, other from Life Spine, other from Integra Life, other from Spine Wave, other from MIEMS, other from Cerapedics, other from AOSpine North America, outside the submitted work; Rick C. Sasso reports grants from AOSpine North America during the conduct of the study; personal fees from medtronic, grants from medtronic, grants from K2, outside the submitted work; Mohamad Bydon reports grants from AOSpine North America during the conduct of the study; Dhananjay Chatterjee reports grants from AOSpine North America during the conduct of the study; Allison K. Roe reports grants from AOSpine North America during the conduct of the study; D. Alex Stroh reports grants from AOSpine North America during the conduct of the study; Marisa Y. Yanez reports grants from AOSpine North America during the conduct of the study.