Background To analyze the efficacy and necessity of multiple lumbar punctures for postoperative delayed lumbar epidural hematoma(PDLEH).
Methods Patients who underwent lumbar spinal surgeries between 2012 and 2016 at our institution, were reviewed through their medical records. For patients with PDLEH, the therapies, duration to onset(DO), duration from onset to intervention (DOI), symptoms (ASIA grade), neurological outcomes, VAS before and after treatment were examined. Only patients that received evacuation surgery(Group A) or mutiple lumbar punctures(MLP)(Group B) were included. We compared ASIA grade and VAS before and after treatment, DOI between the two therapies, and analyzed the correlation among the parameters.
Results 15 cases(Group A) were performed with emergent surgical evacuation of the hematoma, and 16 cases(Group B) were treated with lumbar MLP at surgical site. The DOIs were 10.87±6.14h in group A and 2.05±5.33 in group B(P=0,P<0.05.). Preoperative neurological status in Group A were slighter than that in Group B.(P=0,P<0.05.). There was significant difference on VAS after treatment (P=0,P<0.05). Correlation analysis revealed that DOI were significantly positively correlated with neurological state before interventions (r=0.672, p=0,). In Group A, neurological outcomes at 2 years follow-up were correlated significantly with DOI (r=0.594, p=002) and neurological state before reoperation (r=0.665,p=0.007,). And in Group B, the correlation coefficient of neurological state and neurological outcomes at 2 years follow-up was r=o.584 (p=0.02),while there was no correlation between neurological outcomes and DOI(r=0.158,p=0.558).
Conclusions In addition to serving as a timely, minimally invasive treatment, MLP could also serve as a preliminary measure during preoperative preparation before surgical evacuation.