Why Cannot Suction Drains Prevent Postoperative Spinal Epidural Hematoma?

다국어 초록 (Multilingual Abstract)

Background: Postoperative spinal epidural hematoma (POSEH) is different from spontaneous or post-spinal procedure hematoma because of the application of suction drains. However, it appeared that suction drains were not effective for prevention of POSEH in previous studies. The purpose of this study was to test our hypothesis that POSEH can be caused by hypercoagulability.
Methods: This was an experimental study. One hundred fifty milliliters of blood was donated from each of the 12 consecutive patients who underwent spine surgery and infused into 3 saline bags of 50 mL each. One of the 3 bags in each set contained 5,000 units of thrombin. All of them were connected to 120 ± 30 mmHg vacuum suctions: drainage was started 8 minutes after connection to the vacuum system for 12 normal blood bags (BV8) and 12 thrombin-containing blood bags (TBV8) and 15 minutes after connection for the remaining 12 normal blood bags (BV15). The amount of initial and remaining hematoma at 20 minutes, 120 minutes, and 24 hours after vacuum application were measured by their weight (g). The primary endpoint was the difference between BV8 and TBV8. The secondary end point was the difference between BV8 and BV15.
Results: The remaining hematoma in TBV8 was significantly greater than that in BV8 at all measurement points: 46.3 ± 12.4 vs.
17.0 ± 1.3 (p = 0.000) at 20 minutes; 33.0 ± 8.2 vs. 16.3 ± 1.2 (p = 0.000) at 120 minutes; and 26.1 ± 4.0 vs. 15.8 ± 1.6 (p = 0.000) at 24 hours after vacuum application. The remaining hematoma of BV15 was significantly greater than that of BV8 at all measurement points: 30.0 ± 12.0 vs. 17.0 ± 1.3 (p = 0.002) at 20 minutes; 24.2 ± 7.6 vs. 16.3 ± 1.2 at 120 minutes (p = 0.002); and 22.2 ± 6.6 vs. 15.8 ± 1.6 (p = 0.004) at 24 hours after vacuum application.
Conclusions: With a suction drain in place, the amount of remaining hematoma could be affected by coagulability. Thrombincontaining local hemostatics and the length of time elapsed before the commencement of suction resulted in hypercoagulability, indicating these two factors could be causes of POSEH.

참고문헌 (Reference)

1 Walid MS, "The role of drains in lumbar spine fusion" 77 (77): 564-568, 2012

2 Babayev R, "Spontaneous thoracic epidural hematoma : a case report and literature review" 32 (32): 181-187, 2016

3 Tawk C, "Spontaneous epidural hematoma of the spine associated with oral anticoagulants : 3 case studies" 13 : 8-11, 2015

4 Emori M, "Spinal surgery in a patient with essential thrombocythemia resulting in leg paraplegia: a case report" 13 (13): e7-e10, 2013

5 Kebaish KM, "Spinal epidural hematoma causing acute cauda equina syndrome" 16 (16): e1-, 2004

6 Kou J, "Risk factors for spinal epidural hematoma after spinal surgery" 27 (27): 1670-1673, 2002

7 Sokolowski MJ, "Prospective study of postoperative lumbar epidural hematoma : incidence and risk factors" 33 (33): 108-113, 2008

8 Cabana F, "Postoperative compressive spinal epidural hematomas : 15 cases and a review of the literature" 86 (86): 335-345, 2000

9 이성, "Postoperative Spinal Epidural Hematoma: Risk Factor and Clinical Outcome" 연세대학교의과대학 47 (47): 326-332, 2006

10 Chimenti P, "Post-operative spinal epidural hematoma causing American Spinal Injury Association B spinal cord injury in patients with suction wound drains" 36 (36): 213-219, 2013

11 Korinth MC, "Low-dose aspirin before spinal surgery : results of a survey among neurosurgeons in Germany" 16 (16): 365-372, 2007

12 Scuderi GJ, "Is wound drainage necessary after lumbar spinal fusion surgery?" 11 (11): CR64-CR66, 2005

13 Ahn DK, "Hemophilia A in a senior patient : a case report of spinal epidural hematoma as first presentation" 9 (9): 452-455, 2015

14 Cuellar JM, "Does aspirin administration increase perioperative morbidity in patients with cardiac stents undergoing spinal surgery?" 40 (40): 629-635, 2015

15 Uribe J, "Delayed postoperative spinal epidural hematomas" 3 (3): 125-129, 2003

16 Parker MJ, "Closed suction surgical wound drainage after orthopaedic surgery" (3) : CD001825-, 2007

17 Mirzai H, "Are drains useful for lumbar disc surgery? A prospective, randomized clinical study" 19 (19): 171-177, 2006

18 Awad JN, "Analysis of the risk factors for the development of postoperative spinal epidural haematoma" 87 (87): 1248-1252, 2005

19 Brown MD, "A randomized study of closed wound suction drainage for extensive lumbar spine surgery" 29 (29): 1066-1068, 2004