Optimal timing for decompression in post-operative epidural hematoma: a retrospective analysis and treatment flowchart.

Purpose: Post-operative epidural hematoma is a rare but devastating complication of spine surgery. The importance of timely decompression for preserving neurologic function has been repeatedly stressed, but the acceptable timescale for decompression remains controversial. The purpose of this study was to propose a diagnosis and treatment flowchart for post-operative epidural hematoma.

Methods: A retrospective chart review from the registry database of 93 patients who underwent epidural hematoma evacuation from January 2007 to December 2021 was conducted. Statistical analysis was performed to assess the correlation between recovery of neurologic function and time to decompression.

Results: Sixty patients were included in the statistical analysis. Time to decompression was significantly associated with recovery of neurologic function in the overall analysis and in subgroup analysis of cases of acute post-operative epidural hematoma. As the time to decompression decreases, there is an improvement in the odds of neurological function recovery. Moreover, a critical threshold for the time to decompression was determined to be < 6 h.

Conclusion: Timely decompression is strongly suggested for post-operative epidural hematoma. We proposed a flowchart as a tool to guide treatment of post-operative epidural hematoma. For acute post-operative epidural hematoma, decompression within 6 h promises better neurologic recovery, and decompression should not be delayed by imaging examination. For delayed post-operative epidural hematoma, decompression should be performed as soon as possible after a definite diagnosis is reached.