Highlights
- •CT-guided aspiration was safe, with no post-procedural complications in our cohort.
- •Most patients experienced symptomatic improvement following aspiration.
- •Collections that produced serous fluid were less dense on pre-procedure CT.
- •Volume of fluid aspirated and symptomatic outcome were not associated in our cohort.
Abstract
Sterile postoperative seromas can develop after posterior spinal surgery and cause
pain, weakness, and numbness. Management typically involves operative evacuation.
We propose that these collections can be managed with percutaneous computed tomography
(CT) guided aspiration, potentially saving the patient an additional surgery. Here,
we evaluate the safety and efficacy of this approach. Patients who developed symptomatic
postoperative seromas within 60 days following surgery for spinal canal stenosis and
had stable neurologic exams were considered for CT-guided percutaneous aspiration.
To be considered for this approach, patients had to have pre-procedural evidence of
radiographic spinal cord or cauda equina compression, hemodynamic stability, and low
suspicion for infection. A total of 16 symptomatic collections were aspirated among
15 patients. The mean volume of fluid removed was 32.0 mL. There were no peri- or
post-procedural complications. Eight (50%) had resolution or substantial improvement
of their symptoms (p = 0.0002 when compared to the null hypothesis). One patient had
short interval improvement but return of their initial symptoms 12 h following aspiration,
3/16 (19%) had minimal improvement, and 4/16 (25%) had no change in symptoms. Fluid
collections that appeared denser on the pre-procedural CT were associated with retrieval
of more sanguineous appearing fluid (p = 0.08). Neither the amount nor quality of
fluid aspirated was associated with outcome. We conclude that percutaneous CT-guided
aspiration of postoperative seromas is safe and should be considered as an alternative
to open surgical evacuation in patients with stable neurologic exams.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Clinical NeuroscienceAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Perioperative complications with rhBMP-2 in transforaminal lumbar interbody fusion.Eur Spine J. 2011; 20: 612-617
- The safety and efficacy of anterior cervical discectomy and fusion with polyetheretherketone spacer and recombinant human bone morphogenetic protein-2: a review of 200 patients.J Neurosurg Spine. 2008; 8: 529-535
- Surgical seroma formation following posterior cervical laminectomy and fusion without rhBMP-2.J Neurosurg Spine. 2013; 19: 297-300
- Postoperative spinal epidural hematoma (SEH): incidence, risk factors, onset, management.Spine J. 2013; 13: 134-140
- Sterile seroma resulting from multilevel XLIF procedure as possible adverse effect of prophylactic vancomycin powder: A case report.Evid Based Spine Care J. 2014; 5: 127-133
- A minimally invasive approach for treating postoperative seromas after incisional hernia repair.JSLS. 2001; 5: 267-271
- Seroma formation after breast cancer surgery: what we have learned in the last two decades.J Breast Cancer. 2012; 15: 373-380
- Risk factors associated with 30-day readmissions after instrumented spine surgery in 14,939 patients: 30-day readmissions after instrumented spine surgery.Spine. 2015; 40: 1022-1032
- A multi-center study of reoperations within 30 days of spine surgery.Eur Spine J. 2016; 25: 828-835
- Cytokine-mediated inflammatory reaction following posterior cervical decompression and fusion associated with recombinant human bone morphogenetic protein-2: a case study.Spine. 2010; 35: E1350-E1354
- Symptomatic postoperative spinal epidural hematoma: is evacuation surgery necessary?.Spine J. 2014; 14: 724-725
- Management of wound complications in spinal surgery.Neurosurg Q. 2006; 16: 9-14
Article info
Publication history
Published online: August 25, 2018
Accepted:
August 7,
2018
Received:
February 16,
2018
Identification
Copyright
© 2018 Elsevier Ltd. All rights reserved.
