Assessment of Incidence and the Risk Factors for Spinal Epidural Haematoma Following the Lumbar Spinal Surgery: A Systematic Review and Meta Analysis

Introduction: Spinal epidural hematoma (SEH) is a rare but potentially devastating complication following lumbar spinal surgery. Quantifying its incidence and identifying modifiable risk factors can help optimize informed consent and preventative strategies.

Methods: : A comprehensive search strategy was developed to identify all relevant studies reporting on the incidence and risk factors of spinal epidural hematoma following lumbar spinal surgery. EMBASE, Web of Science, CINAHL, PubMed, and the Cochrane Library were among the major electronic databases that were searched in order to find published literature up to June 27, 2024. Observational cohort studies reporting incidence of SEH or comparing outcomes between exposure groups for potential risk factors were included. Data on study characteristics, patient demographics, outcome definitions and effects were extracted. Random-effects meta-analyses were performed to estimate pooled incidence and odds ratios (OR) for risk factors. Heterogeneity was evaluated using I2 on the Review Manager 5 and STATA 17.

Results: Thirteen studies (n=35724 patients) were included to estimate pooled SEH incidence. Three to five studies each evaluated advanced age, multilevel procedures and preoperative coagulopathy as risk factors. Pooled SEH incidence was 0.13% (95% CI 0.10-0.16, I2=98%). Advanced age significantly increased risk (pooled OR 14.73, 95% CI 11.99-18.07, I2=98%), as did multilevel procedures (OR 0.01, 95% CI 0.01-0.01, I2=0%) and preoperative coagulopathy (OR 0.03, 95% CI 0.02-0.04, I2=98%).

Conclusion : This systematic review and meta-analysis estimated a low SEH incidence of 0.13% following lumbar surgery. Advanced age, multilevel procedures and preoperative coagulopathy were identified as significant risk factors. However, limitations from heterogeneity and observational study designs preclude definitive conclusions. Further rigorous research is needed to optimize prediction and prevention of this serious complication.