The Comarr Memorial Award for Distinguished Clinical Service: The Legacy of A. Estin Comarr,MD |
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Authors: | Donald R Bodner MD |
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Affiliation: | 1. Department of Urology, UH Case Western Medical Center, CWRU, Cleveland, Ohiodbodner180@aol.com |
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Abstract: | AbstractBackgroundSubfascial wound suction drains are commonly used after spinal surgery to decrease the incidence of post-operative hematoma. However, there is a paucity of literature regarding their effectiveness.ObjectiveTo report four cases of post-operative spinal epidural hematoma causing massive neurological deficit in patients who had subfascial suction wound drains.MethodsDuring an 8-year period, a retrospective review of 1750 consecutive adult spinal surgery cases was performed to determine the incidence, commonalities, and outcomes of catastrophic neurological deficit caused by post-operative spinal epidural hematoma.FindingsEpidural hematoma causing major neurological deficit (American Spinal Injury Association B) was identified in 4 out of 1750 patients (0.23%). All four patients in this series had subfascial wound suction drains placed prophylactically at the conclusion of their initial procedure.ResultsThree patients developed massive neurological deficits with the drain in place; one patient had the drain removed at 24 hours and subsequently developed neurological symptoms during the following post-operative day. Significant risk factors for the development of hematoma were identified in two of the four patients. Average time to return to the operating room for hematoma evacuation was 6 hours (range 3–12 hours). Neurological status significantly improved in all four patients after hematoma evacuation.ConclusionsPost-operative epidural hematoma causing catastrophic neurological deficit is a rare complication after spinal surgery. The presence of suction wound drains does not appear to prevent the occurrence of this devastating complication. |
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Keywords: | Epidural hematoma Suction drainage Spinal cord injuries Laminectomy Spinal decompression |
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