Perspective/short review: Critical early diagnosis and emergency treatment for thoracic epidural hematomas.
- 1Professor 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.
- 2Assistant Clinical Professor of Orthopedics, NYU Langone Hospital Long Island, NY, USA, 1122 Franklin Avenue, Suite 106, Garden City, NY 11530, USA.
Abstract
Background
We 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
We 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
Reported 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
Postoperative 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.
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BibTeX
@article{epstein2026perspectiveshort,
title = {{Perspective/short review: Critical early diagnosis and emergency treatment for thoracic epidural hematomas.}},
author = {Nancy E Epstein and Marc A Agulnick},
journal = {Surgical neurology international},
year = {2026},
month = oct,
doi = {10.25259/sni_1123_2026},
url = {https://europepmc.org/article/MED/42974235},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Perspective/short review: Critical early diagnosis and emergency treatment for thoracic epidural hematomas.
AU - Nancy E Epstein
AU - Marc A Agulnick
PY - 2026
DA - 2026/10/02
JO - Surgical neurology international
DO - 10.25259/sni_1123_2026
UR - https://europepmc.org/article/MED/42974235
AB - Background We 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 We 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 Reported 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 Postoperative 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.
SN - 2229-5097
SN - 2152-7806
ER -