• Yasushi Fujiwara, Hideki Manabe, Bunichiro Izumi, Takahiro Harada, Kazuyoshi Nakanishi, Nobuhiro Tanaka, and Nobuo Adachi.
• Department of Orthopaedic Surgery, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabe-Minami, Asa-kita-ku, Hiroshima, Hiroshima, 731-0293, Japan. ys.fujiwara@nifty.com.
• Eur Spine J. 2017 Oct 1; 26 (10): 2606-2615.

PurposePostoperative spinal epidural hematoma (PSEH) is one of the most hazardous complications after spine surgery. A recent study has reported that a ≥50 mmHg increase in systolic blood pressure after extubation was a significant risk factor for symptomatic PSEH. In this paper, the impact of hypertension on PSEH occurrence was investigated.MethodsAmong a total of 2468 patients who underwent single level microscopic posterior decompression surgery for lumbar spinal stenosis in a single institute, 15 (0.6%) received evacuation surgery for PSEH. Those 15 patients were investigated statistically compared with a randomly selected control group (n = 46) using the Mann-Whitney U test and multiple logistic regression analysis.ResultsThe univariate analysis showed that there were no significant differences in age, gender, BMI, pre-operative anti-coagulant usage, intraoperative blood loss, operation time, and the rate of patients who received pre-operative hypertension treatment. However, there were significant differences in the rate of patients who showed high blood pressure at admission (66.7 vs 6.5%) and >50 mmHg increases in blood pressure after extubation (53.3 vs 17.4%) in the univariate analysis. Moreover, postoperatively, there was a statistical difference in the amount of post-operative drainage. Multiple logistic regression analysis showed that high blood pressures at admission and poor postoperative drainage were the essential risk factors.ConclusionsOur results demonstrate that the pre-operative high blood pressure value was the most essential risk factor for PSEH, although there was no difference in the preoperative hypertension treatment. Consequently, management of pre-operative blood pressure and post-operative drainage will be crucial for preventing PSEH.

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