Remodeling of Epidural Fluid Hematoma after Uniportal Lumbar Endoscopic Unilateral Laminotomy with Bilateral Decompression: Comparative Clinical and Radiological Outcomes with a Minimum Follow-up of 2 Years

Pang Hung Wu; Hyeun Sung Kim; Giovanni Grasso; Jin Woo An; Myeonghun Kim; Inkyung Lee; Jong Seon Park; Jun Hyoung Lee; Sangsoo Kang; Jeongshik Lee; Yeonjin Yi; Jun Hyung Lee; Jun Hwan Park; Jae Hyeon Lim; Il-Tae Jang

doi:10.31616/asj.2021.0366

Remodeling of Epidural Fluid Hematoma after Uniportal Lumbar Endoscopic Unilateral Laminotomy with Bilateral Decompression: Comparative Clinical and Radiological Outcomes with a Minimum Follow-up of 2 Years

Asian Spine J. 2023 Feb;17(1):118-129. doi: 10.31616/asj.2021.0366. Epub 2022 Jul 4.

Authors

Affiliations

¹ Spine Surgery, Nanoori Gangnam Hospital, Seoul, Korea.
² Department of Orthopaedic Surgery, Juronghealth Campus, National University Health System, Singapore.
³ Neurosurgical Clinic, Department of Biomedicine, Neurosciences and Advanced Diagnostics University for Palermo, Palermo, Italy.
⁴ Nanoori Spine and Joint Clinic with Saudi German Hospital in Dubai, Dubai, United Arab Emirates.
⁵ Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea.
⁶ Faculty of Medicine, University of Debrecen, Debrecen, Hungary.

Abstract

Study design: Retrospective cohort study.

Purpose: To evaluate the clinical and radiological effects of epidural fluid hematoma in the medium term after lumbar endoscopic decompression.

Overview of literature: There is limited literature comparing the effect of postoperative epidural fluid hematoma after uniportal endoscopic decompression.

Methods: Magnetic resonance imaging (MRI) and clinical evaluation were performed for patients with single-level uniportal endoscopic lumbar decompression with a minimum follow-up of 2 years.

Results: A total of 126 patients were recruited with a minimum follow-up of 26 months. The incidence of epidural fluid hematoma was 27%. Postoperative MRI revealed a significant improvement in the postoperative dura sac area at postoperative day 1 and at the upper endplate at 6 months in the hematoma cohort (39.69±15.72 and 26.89±16.58 mm2) as compared with the nonhematoma cohort (48.92±21.36 and 35.1±20.44 mm2), respectively (p <0.05); and at the lower endplate on postoperative 1 day in the hematoma cohort (51.18±24.69 mm2) compared to the nonhematoma cohort (63.91±27.92 mm2) (p <0.05). No significant difference was observed in the dura sac area at postoperative 1 year in both cohorts. The hematoma cohort had statistically significant higher postoperative 1-week Visual Analog Scale (VAS; 3.32±0.68) pain and Oswestry Disability Index (ODI; 32.65±5.56) scores than the nonhematoma cohort (2.99±0.50 and 30.02±4.84, respectively; p <0.05). No significant difference was found at the final follow-up VAS, ODI, and MRI dura sac area.

Conclusions: Epidural fluid hematoma is a common early postoperative MRI finding in lumbar endoscopic unilateral laminotomy with bilateral decompression. Conservative management is the preferred treatment option for patients who do not have a neurological deficit. Symptoms last only a few days and are self-limiting. A common endpoint is a remodeled fluid hematoma and the subsequent expansion of the dura sac area.

Keywords: Endoscopic spine surgery; Lumbar endoscopic unilateral laminotomy for bilateral decompression; Minimally invasive surgical procedures; Postoperative complications; Spinal epidural hematoma; Spinal stenosis; Spine.