Spinal epidural hematoma evacuation

Epidural hematoma is not uncommon in spinal canal diseases. The causes are spinal surgery, epidural anesthesia, spinal vascular disease, anticoagulant therapy, spinal cord injury, etc., and thoracic segments are more common. After the onset of the disease, the patient rapidly developed spinal cord dysfunction, and there was limb sensation and sphincter dysfunction, indicating incomplete or complete paraplegia. Generally, according to the Frankel method, functional grading: grade A, complete spinal cord injury, sensory, motor and sphincter function disappeared completely below the injury plane; grade B, only the sensory presence exists below the injury plane; grade C, limb activity, but no function; Class D, limbs have functional activities; Class E, normal function. MRI examination: the epidural space is convex mirror-shaped lesion, the edge is clear, T1 is equal signal, T2 is low signal, spinal cord compression displacement is obvious, suggesting the signs of acute epidural hematoma. If the clinical symptoms develop severely, complete sexual dysfunction or only some sensations below the damaged plane (Frankel A or B) should be considered as an emergency. Clinical experience suggests that treatment outcomes are associated with pre-operative symptoms and the length of time from the onset of symptoms to the time of surgery. Lowton et al (1995) reported that in 30 cases, Frankel A and B grades had good surgical results within 12 hours, and the operation time was later, and spinal cord function recovery was poor. Groen et al (1996) reviewed 330 patients reported in the literature, preoperatively complete motor and sensory loss (Frankel A grade) within 36h surgery and incomplete paralysis within 48h, can also achieve certain functional improvements. However, the delay in multi-day surgery has serious consequences. Treatment of diseases: spinal cord injury, spinal cord abscess Indication Spinal epidural hematoma evacuation is applicable to: Spinal trauma, spinal surgery, epidural anesthesia or other unexplained causes, sudden back pain, numbness in both legs, progressive dyskinesia. MRI examination showed epidural space-occupying lesions, with the greatest possibility of hematoma, surgery should be performed; if the development of two lower extremity lesions or close to complete paralysis, surgery should not be delayed. Contraindications The above-mentioned trauma, surgery or anesthesia, etc., caused complete paraplegia for a dozen days or weeks, the hematoma has been absorbed, MRI showed no obvious signs of spinal cord compression, surgery is no longer necessary. Surgical procedure 1. The midline incision is made centering on the location of the hematoma. The length of the incision is appropriate to expose the three laminas. The paravertebral muscles are separated and the retractor is opened. 2, the general removal of 2 lamina can meet the need to clear the hematoma, a large range of hematoma, can be appropriate to expand the laminectomy. Absorbing hemorrhage with a suction device until the dura mater is revealed, and bipolar electrocoagulation is used to stop bleeding for active bleeding. If a deformed vascular mass is found, it can be removed. If there is a suspected subdural lesion, if necessary, the dura mater can be invaded and explored according to the findings. 3. Slot the incision layer by layer. complication 1, spinal epidural hematoma paravertebral muscles, vertebrae and epidural venous plexus hemostasis, hematoma can be formed after surgery, resulting in limb paralysis, more than 72h after surgery. A hematoma can occur even when the drainage tube is placed. If this phenomenon occurs, it should be actively checked to remove the hematoma and completely stop bleeding. 2, spinal edema is often caused by surgical operation of the injured spinal cord, clinical manifestations similar to hematoma. The treatment is mainly dehydration and hormones; in severe cases, the dura mater has been sutured, and the operation can be performed again to open the dura mater. 3, cerebrospinal fluid leakage due to dull suture and / or muscle layer suture is not strict. If there is drainage, it should be removed in advance. If the leakage is less, the dressing is observed. If it cannot be stopped or the fluid is leaked, the leak should be sutured in the operating room. 4, wound infection, cracking is generally poor, incision healing ability or cerebrospinal fluid leakage is easy to occur. Intraoperative attention should be paid to aseptic operation. In addition to antibiotic treatment, it should actively improve the general condition, paying special attention to the supplement of protein and multivitamins. Special parts such as between the shoulder blades should be reinforced with muscle layer sutures.

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