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Wang L, Wang H, Sun Z, Chen Z, Sun C, Li W. Incidence and Risk Factors for Symptomatic Spinal Epidural Hematoma Following Posterior Thoracic Spinal Surgery in a Single Institute. Global Spine J 2022; 12:1175-1183. [PMID: 33334185 PMCID: PMC9210222 DOI: 10.1177/2192568220979141] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
STUDY DESIGN Case-control study. OBJECTIVES To investigate the incidence of symptomatic spinal epidural hematoma (SSEH) and recognize its risk factors in a cohort of patients undergoing posterior thoracic surgery in isolation. METHODS From January 2010 to December 2019, patients who developed SSEH after posterior thoracic surgery and underwent hematoma evacuation were enrolled. For each SSEH patient, 2 or 3 controls who did not develop SSEH and underwent the same procedures with similar complexity at the same section of the thoracic spine in the same period were collected. The preoperative and intraoperative factors, blood pressure-related factors and radiographic parameters were collected to identify possible risk factors by comparing between the 2 groups. RESULTS A total of 24 of 1612 patients (1.49%) were identified as having SSEH after thoracic spinal surgery. Compared to the control group (53 patients), SSEH patients had significant differences in the APTT (p = 0.028), INR (p = 0.009), ratio of previous spinal surgery (p = 0.012), ratio of cerebrospinal fluid leakage (p = 0.004), thoracic kyphosis (p<0.05), local kyphosis angle (p<0.05), epidural fat ratio at T7 (p = 0.003), occupying ratio of the cross-sectional area (p<0.05) and spinal epidural venous plexus grade (p<0.05). Multiple logistic regression analysis revealed 3 risk factors for SSEH: cerebrospinal fluid leakage, the local kyphosis angle (>8.77°) and the occupying ratio of the cross-sectional area (>49.58%). CONCLUSIONS The incidence of SSEH was 1.49% in posterior thoracic spinal surgeries. Large local kyphosis angle (>8.77°), high occupying ratio of cross-sectional area (>49.58%) and cerebrospinal fluid leakage were identified as risk factors for SSEH.
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Affiliation(s)
- Longjie Wang
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Hui Wang
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Zhuoran Sun
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Zhongqiang Chen
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Chuiguo Sun
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Beijing, China,Weishi Li, MD, Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, China.
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Dinger TF, Eerikäinen MS, Michel A, Gembruch O, Darkwah Oppong M, Chihi M, Blau T, Uerschels AK, Pierscianek D, Deuschl C, Jabbarli R, Sure U, Wrede KH. A New Subform? Fast-Progressing, Severe Neurological Deterioration Caused by Spinal Epidural Lipomatosis. J Clin Med 2022; 11:jcm11020366. [PMID: 35054059 PMCID: PMC8781155 DOI: 10.3390/jcm11020366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/03/2022] [Accepted: 01/10/2022] [Indexed: 02/04/2023] Open
Abstract
Spinal epidural lipomatosis (SEL) is a rare condition caused by hypertrophic growth of epidural fat. The prevalence of SEL in the Western world is approximately 1 in 40 patients and is likely to increase due to current medical and socio-economic developments. Rarely, SEL can lead to rapid severe neurological deterioration. The pathophysiology, optimal treatment, and outcome of these patients remain unclear. This study aims to widen current knowledge about this “SEL subform” and to improve its clinical management. A systematic literature review according to the PRISMA guidelines using PubMed, Scopus, Web of Science, and Cochrane Library was used to identify publications before 7 November 2021 reporting on acute/rapidly progressing, severe SEL. The final analysis comprised 12 patients with acute, severe SEL. The majority of the patients were male (9/12) and multimorbid (10/12). SEL mainly affected the thoracic part of the spinal cord (11/12), extending a median number of 7 spinal levels (range: 4–19). Surgery was the only chosen therapy (11/12), except for one critically ill patient. Regarding the outcome, half of the patients regained independence (6/11; = modified McCormick Scale ≤ II). Acute, severe SEL is a rare condition, mainly affecting multimorbid patients. The prognosis is poor in nearly 50% of the patients, even with maximum therapy. Further research is needed to stratify patients for conservative or surgical treatment.
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Affiliation(s)
- Thiemo Florin Dinger
- Department of Neurosurgery and Spine Surgery, University Hospital of Essen, University of Duisburg-Essen, 47057 Duisburg, Germany; (A.M.); (O.G.); (M.D.O.); (M.C.); (A.-K.U.); (D.P.); (R.J.); (U.S.); (K.H.W.)
- Correspondence: ; Tel.: +49-201-723-1201
| | - Maija Susanna Eerikäinen
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, 47057 Duisburg, Germany; (M.S.E.); (C.D.)
| | - Anna Michel
- Department of Neurosurgery and Spine Surgery, University Hospital of Essen, University of Duisburg-Essen, 47057 Duisburg, Germany; (A.M.); (O.G.); (M.D.O.); (M.C.); (A.-K.U.); (D.P.); (R.J.); (U.S.); (K.H.W.)
| | - Oliver Gembruch
- Department of Neurosurgery and Spine Surgery, University Hospital of Essen, University of Duisburg-Essen, 47057 Duisburg, Germany; (A.M.); (O.G.); (M.D.O.); (M.C.); (A.-K.U.); (D.P.); (R.J.); (U.S.); (K.H.W.)
| | - Marvin Darkwah Oppong
- Department of Neurosurgery and Spine Surgery, University Hospital of Essen, University of Duisburg-Essen, 47057 Duisburg, Germany; (A.M.); (O.G.); (M.D.O.); (M.C.); (A.-K.U.); (D.P.); (R.J.); (U.S.); (K.H.W.)
| | - Mehdi Chihi
- Department of Neurosurgery and Spine Surgery, University Hospital of Essen, University of Duisburg-Essen, 47057 Duisburg, Germany; (A.M.); (O.G.); (M.D.O.); (M.C.); (A.-K.U.); (D.P.); (R.J.); (U.S.); (K.H.W.)
| | - Tobias Blau
- Institute of Neuropathology, University Hospital of Essen, University of Duisburg-Essen, 47057 Duisburg, Germany;
| | - Anne-Kathrin Uerschels
- Department of Neurosurgery and Spine Surgery, University Hospital of Essen, University of Duisburg-Essen, 47057 Duisburg, Germany; (A.M.); (O.G.); (M.D.O.); (M.C.); (A.-K.U.); (D.P.); (R.J.); (U.S.); (K.H.W.)
| | - Daniela Pierscianek
- Department of Neurosurgery and Spine Surgery, University Hospital of Essen, University of Duisburg-Essen, 47057 Duisburg, Germany; (A.M.); (O.G.); (M.D.O.); (M.C.); (A.-K.U.); (D.P.); (R.J.); (U.S.); (K.H.W.)
| | - Cornelius Deuschl
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, 47057 Duisburg, Germany; (M.S.E.); (C.D.)
| | - Ramazan Jabbarli
- Department of Neurosurgery and Spine Surgery, University Hospital of Essen, University of Duisburg-Essen, 47057 Duisburg, Germany; (A.M.); (O.G.); (M.D.O.); (M.C.); (A.-K.U.); (D.P.); (R.J.); (U.S.); (K.H.W.)
| | - Ulrich Sure
- Department of Neurosurgery and Spine Surgery, University Hospital of Essen, University of Duisburg-Essen, 47057 Duisburg, Germany; (A.M.); (O.G.); (M.D.O.); (M.C.); (A.-K.U.); (D.P.); (R.J.); (U.S.); (K.H.W.)
| | - Karsten Henning Wrede
- Department of Neurosurgery and Spine Surgery, University Hospital of Essen, University of Duisburg-Essen, 47057 Duisburg, Germany; (A.M.); (O.G.); (M.D.O.); (M.C.); (A.-K.U.); (D.P.); (R.J.); (U.S.); (K.H.W.)
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Yadav N, Hedaoo K, Kumar A. Spinal Epidural Lipomatosis Associated with Intrathecal Flow Voids: Demonstration of Engorged Veins Using Flat Panel Catheter Angiotomography. J Neurosci Rural Pract 2021; 13:137-140. [PMID: 35110935 PMCID: PMC8803513 DOI: 10.1055/s-0041-1736510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
We present a case of a 54-year-old male with spinal epidural lipomatosis who had associated flow voids on magnetic resonance imaging with dilated intrathecal vessels. During spinal angiogram, 20s DynaCT (flat panel catheter angiotomography) was utilized to demonstrate the intrathecal engorged veins. Venous engorgement of epidural venous plexus has been previously described in epidural lipomatosis; however, dilated intrathecal perimedullary veins have not been demonstrated by imaging. We have described the utility of flat panel catheter angiotomography in understanding venous disorders in such patients.
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Affiliation(s)
- Nishtha Yadav
- Department of Neuroradiology, School of Excellence in Neurosurgery, Super Speciality Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
| | - Ketan Hedaoo
- Department of Neurosurgery, Super Speciality Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
| | - Ambuj Kumar
- Department of Neurosurgery, Super Speciality Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
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Hallan DR, McNutt S, Reiter GT, Thamburaj K, Specht CS, Knaub M. Dilated Epidural Venous Plexus Causing Radiculopathy: A Report of 2 Cases and Review of the Literature. World Neurosurg 2020; 144:231-237. [PMID: 32961358 DOI: 10.1016/j.wneu.2020.09.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/23/2020] [Accepted: 09/08/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND A dilated epidural venous plexus (DEVP) is a rare cause of radiculopathy, back pain, cauda equina syndrome, and other neurological symptoms. This vascular mass can be secondary to inferior vena cava obstruction, portal hypertension, vascular agenesis, and hypercoagulable states. Although rare, DEVP should be considered in the differential diagnosis for patients who present with lumbar radiculopathy. CASE DESCRIPTION We present 2 cases involving patients with lumbar DEVP as well as a literature review of the role of hypercoagulability, vascular anatomy, and inferior vena cava thrombosis in the development of DEVP. The first patient had a history of recurrent deep vein thrombosis, systemic lupus erythematosus, and antiphospholipid syndrome. The diagnosis of DEVP was determined after intraoperative biopsy. The patient reported symptom resolution at her 6-month postoperative appointment. The second patient developed DEVP associated with Klippel-Trenaunay syndrome. She presented with back pain and leg weakness, and DEVP was diagnosed via magnetic resonance imaging. A neurosurgeon is currently following the patient. We believe this is the first case of Klippel-Trenaunay syndrome associated with DEVP. CONCLUSIONS If a patient presents with an enhancing epidural lesion on magnetic resonance imaging and neurological symptoms, DEVP should be considered in the differential diagnosis. Additionally, a search for inferior vena cava thrombosis should be performed as well as risk factors for venous hypertension and hypercoagulable states.
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Affiliation(s)
- David R Hallan
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.
| | - Sarah McNutt
- Department of Pennsylvania State College of Medicine, Hershey, Pennsylvania, USA
| | - G Timothy Reiter
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Krishnamoorthy Thamburaj
- Department of Neuroradiology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Charles S Specht
- Department of Pathology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Mark Knaub
- Department of Orthopaedic Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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