{
  "abstract": "Background\n\nWe reviewed published studies describing postoperative spinal hematomas (ESH) across all spinal levels, with an emphasis on thoracic cases. Postoperative epidural spinal hematomas (ESH) most commonly occur in the thoracic spine, followed by the lumbar and cervical regions. They may arise in association with anticoagulation or antiplatelet therapy, epidural anesthesia or interventional procedures, trauma, or spinal decompression and/or fusion. Thoracic ESH (TESH) represent the highest risk group, with reported incidences ranging from 0.12% to 4.46%.Methods\n\nWe assessed the varied etiologies of ESH/TESH, and analyzed the multitude of risk factors, imaging findings, and optimal timing of surgical intervention for addressing these lesions.Results\n\nReported incidences of postoperative epidural spinal hematomas (ESH) ranged from 0.1-3%, with pooled studies showing an overall rate of ~0.52-0.69%. Notably, thoracic procedures (TESH) occurred more frequently, with rates ranging from 0.12% to 4.46%. One review of 40 studies found a 0.52% overall incidence of ESH, including 0.84% thoracic, 0.63% lumbar, and 0.32% cervical lesions. Multilevel ESH/TESH hematomas were more common after posterior (0.70%) vs. anterior (0.24%) surgery, and were five-fold more frequent following minimally invasive (1.94%) vs. open procedures (0.42%).Conclusions\n\nPostoperative epidural spinal hematomas occur in ~0.52-0.69% of spinal procedures, with thoracic lesions showing higher reported rates (0.12%-4.46%). The strongest predictors of neurological recovery included; the rapid recognition of new postoperative neurological deficits, immediate postoperative MR studies, and emergency surgery. We therefore recommend early/STAT diagnosis and surgery for ESH/TESH (i.e. performed as soon as possible rather than simpley within a < 24 h window) to optimize outcomes.",
  "abstract_shown": true,
  "affiliations": [
    "Professor of Clinical Neurosurgery, School of Medicine, State University of NY at Stony Brook, NY, c/o Dr. Marc Agulnick 1122 Franklin Avenue Suite 106,Garden City, NY 11530, USA and Editor-in-Chief Surgical Neurology International.",
    "Assistant Clinical Professor of Orthopedics, NYU Langone Hospital Long Island, NY, USA, 1122 Franklin Avenue, Suite 106, Garden City, NY 11530, USA."
  ],
  "article_type": "review article",
  "arxiv": null,
  "author_total": 2,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Nancy E Epstein"
    },
    {
      "affs": [
        1
      ],
      "name": "Marc A Agulnick"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/9s3deh2yvfkgj.bib",
  "cited_by": 0,
  "doi": "10.25259/sni_1123_2026",
  "fulltext_url": "https://europepmc.org/articles/PMC13726831",
  "id": "9s3deh2yvfkgj",
  "issns": [
    "2229-5097",
    "2152-7806"
  ],
  "landing_url": "https://europepmc.org/article/MED/42974235",
  "language": "eng",
  "licence": "CC-BY-NC-SA",
  "licence_label": "CC BY-NC-SA",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-sa/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Review Article"
    ],
    [
      "openalex",
      "2746|Spinal Hematomas and Complications"
    ]
  ],
  "openalex": "W7215065361",
  "pdf_url": "https://europepmc.org/articles/PMC13726831?pdf=render",
  "pmcid": "PMC13726831",
  "pmid": "42974235",
  "published": "2026-10-02",
  "publisher": "Scientific Scholar",
  "ris": "https://research.draconitic.com/paper/9s3deh2yvfkgj.ris",
  "sources": [
    {
      "first_seen": "2026-11-04T15:20:49Z",
      "native_id": "MED:42974235",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42974235"
    },
    {
      "first_seen": "2026-11-05T12:23:04Z",
      "native_id": "PMC13726831",
      "source": "pmc",
      "url": "https://doi.org/10.25259/sni_1123_2026"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Spinal Hematomas and Complications",
      "subfield": "surgery"
    }
  ],
  "title": "Perspective/short review: Critical early diagnosis and emergency treatment for thoracic epidural hematomas.",
  "title_text": "Perspective/short review: Critical early diagnosis and emergency treatment for thoracic epidural hematomas.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-06T12:22:40Z",
  "url": "https://research.draconitic.com/paper/9s3deh2yvfkgj",
  "venue": "Surgical neurology international",
  "versions": []
}