Clinical characteristics and risk factors of intracranial hemorrhage after spinal surgery

Xin Yan; Li-Rong Yan; Zhi-Gang Ma; Ming Jiang; Yang Gao; Ying Pang; Wei-Wei Wang; Zhao-Hui Qin; Yang-Tong Han; Xiao-Fan You; Wei Ruan; Qian Wang

doi:10.12998/wjcc.v11.i23.5430

Clinical characteristics and risk factors of intracranial hemorrhage after spinal surgery

World J Clin Cases. 2023 Aug 16;11(23):5430-5439. doi: 10.12998/wjcc.v11.i23.5430.

Authors

Xin Yan¹, Li-Rong Yan², Zhi-Gang Ma², Ming Jiang², Yang Gao³, Ying Pang², Wei-Wei Wang², Zhao-Hui Qin², Yang-Tong Han², Xiao-Fan You², Wei Ruan², Qian Wang⁴

Affiliations

¹ Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China. ynxn0403@163.com.
² Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China.
³ Medical Record Management and Statistics, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China.
⁴ Department of Endocrinology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China.

Abstract

Background: Intracranial hemorrhage after spinal surgery is a rare and devastating complication.

Aim: To investigate the economic burden, clinical characteristics, risk factors, and mechanisms of intracranial hemorrhage after spinal surgery.

Methods: A retrospective cohort study was conducted from January 1, 2015, to December 31, 2022. Patients aged ≥ 18 years, who had undergone spinal surgery were included. Intracranial hemorrhage patients were selected after spinal surgery during hospitalization. Based on the type of spinal surgery, patients with intracranial hemorrhage were randomly matched in a 1:5 ratio with control patients without intracranial hemorrhage. The patients' pre-, intra-, and post-operative data and clinical manifestations were recorded.

Results: A total of 24472 patients underwent spinal surgery. Six patients (3 males and 3 females, average age 71.3 years) developed intracranial hemorrhage after posterior spinal fusion procedures, with an incidence of 0.025% (6/24472). The prevailing type of intracranial hemorrhage was cerebellar hemorrhage. Two patients had a poor clinical outcome. Based on the type of surgery, 30 control patients were randomly matched in 1:5 ratio. The intracranial hemorrhage group showed significant differences compared with the control group with regard to age (71.33 ± 7.45 years vs 58.39 ± 8.07 years, P = 0.001), previous history of cerebrovascular disease (50% vs 6.7%, P = 0.024), spinal dura mater injury (50% vs 3.3%, P = 0.010), hospital expenses (RMB 242119.1 ± 87610.0 vs RMB 96290.7 ± 32029.9, P = 0.009), and discharge activity daily living score (40.00 ± 25.88 vs 75.40 ± 18.29, P = 0.019).

Conclusion: The incidence of intracranial hemorrhage after spinal surgery was extremely low, with poor clinical outcomes. Patient age, previous stroke history, and dura mater damage were possible risk factors. It is suggested that spinal dura mater injury should be avoided during surgery in high-risk patients.

Keywords: Dura mater damage; Economic burden; Intracranial hemorrhage; Risk factors; Spinal surgery.