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KMID : 1148120180080010001
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Journal of Advanced Spine Surgery
2018 Volume.8 No. 1 p.1 ~ p.6
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Can We Reduce Postoperative Spinal Epidural Hematoma by Heparin Instillation Into the Epidural Space?
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Kim Jin-Hak
Ahn Dong-Ki
Shin Won-Shik
Yoo In-Sun
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Abstract
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Study Design: Quasi random prospective controlled study.
Objectives: To verify the hypothesis that nerve compression by postoperative spinal epidural hematoma (POSEH) can be reduced by instillation of heparin through suction drains.
Materials and Methods: The patients who underwent posterior decompression and instrumentation between Jan. 2016 and Jun 2016 were allocated to study (using heparin) group and control group according to the operation date alternately. There were 61 cases in study group and 60 cases in control group. Two lines of suction drain were used in all cases. Thousand unit of heparin and 5ml of normal saline were instilled through the drain lines into the epidural space just before the wound closure. To prove the homogeneity between the two groups, demographic, patient related, operation related and clotting related data were compared. At day 7 after the operation, their MRIs were examined. The area of thecal sac was measured at the T2 weighted axial image that showed the maximal compression of the thecal sac by epidural hematoma. Two orthopedic doctors who were blinded to this study measured independently and the average values of the two were counted as final measured values.
Results: The two groups were homogenous in age, sex, number of fusion segments, whether virgin or revision operation, total blood loss, operation time, blood loss/10 min, whether taking anti-platelet drugs or not, platelet count, PT, aPTT and platelet function analysis. The smallest area of thecal sac in axial MRI was 124.4±49.9 mm2 in study group and 121.7±47.4 mm2 in control group. There was no significant difference (p=0.761)
Conclusions: In a posterior spine surgery, thecal sac compression by POSEH was not reduced by instillation of heparin into the epidural space.
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KEYWORD
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Postoperative spinal epidural hematoma, Suction drain, Heparin, Clotting retardation
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