Clinical characteristics and risk factors of intracranial hemorrhage after spinal surgery

Table 1 Demographics and health economics in the two groups, n (%)

	Hemorrhage group, n = 6	Control group, n = 30	P value
Age (yr)	71.33 ± 7.45	58.39 ± 8.07	0.001a
Gender (Male)	3 (50)	17 (56.7)	1.000
BMI (kg/m2)	27.16 ± 2.17	26.47 ± 3.72	0.667
Hypertension	5 (83.3)	15 (60)	0.169
Diabetes mellitus	1 (16.7)	5 (16.7)	1.000
Hyperlipidemia	1 (16.7)	3 (10)	0.535
Coronary heart disease	0 (0)	2 (6.7)	1.000
Cerebral vascular disease	3 (50)	2 (6.7)	0.024a
Smoking	2 (33.3)	3 (10)	0.186
Alcohol drinking	1 (16.7)	2 (6.7)	0.431
Hospital Cost (RMB)	242119.1 ± 87610.0	96290.7 ± 32029.9	0.009a
Admission ADL	78.33 ± 31.73	90.33 ± 14.50	0.403
Discharge ADL	40.00 ± 25.88	75.40 ± 18.29	0.019a
LOS (d)	60.17 ± 74.71	13.27± 3.73	0.185
ICU stay (h)	310.18 ± 235.82	1.26 ± 4.85	0.024a

^aP < 0.05.

BMI: Body mass index; ADL: Activity daily living; LOS: Length of hospital stay; ICU: Intensive care unit.

Table 2 Analysis of surgery-related risk factors in the two groups, n (%)

	Hemorrhage group, n = 6	Control group, n = 30	P value
Surgery time (min)	177.50 ± 50.97	149.67 ± 69.06	0.357
Blood loss during surgery (mL)	433.33 ± 350.24	327.67 ± 301.94	0.451
Max systolic BP (mmHg)	150.00 ± 22.14	139.47 ± 27.34	0.381
Fluctuating systolic BP (mmHg)	47.50 ± 16.66	39.00 ± 17.49	0.282
Dura damage	3 (50.0)	1 (3.3)	0.010a
Fusion instrument	4 (66.7)	10 (33.3)	0.181
Pedicle screw fixation	4 (66.7)	23 (76.7)	0.627
Plasma transfusion (mL)	633.33 ± 898.15	20.00 ± 109.55	0.155
RBC transfusion (U)	2.00 ± 2.53	0.20 ± 0.81	0.143
Subfascial drainage (mL)	1804.83 ± 1284.60	695.33 ± 507.85	0.088

^aP < 0.05.

BP: Blood pressure; RBC: Red blood cell.

Table 3 Analysis of laboratory examinations in the two groups, n (%)

	Hemorrhage group, n = 6	Control group, n = 30	P value
WBC (109/L)	6.05 ± 1.18	6.43 ± 1.60	0.584
RBC (1012/L)	4.72 ± 0.43	4.75 ± 0.39	0.852
HBG (g/L)	144.33 ± 10.73	146.23 ± 11.90	0.720
PLT (109/L)	189.83 ± 70.59	227.70 ± 48.17	0.113
HCT (%)	42.22 ± 3.60	44.24 ± 8.29	0.565
ALT (IU/L)	19.67 ± 9.73	21.20 ± 11.78	0.767
AST (IU/L)	19.33 ± 4.72	21.67 ± 6.40	0.404
ALP (IU/L)	69.83 ± 14.93	61.63 ± 15.88	0.252
GLU (mmol/L)	5.10 ± 0.49	5.69 ± 1.18	0.059
UREA (mmol/L)	5.45 ± 1.67	5.29 ± 1.29	0.798
CREA (umol/L)	67.00 ± 17.75	62.23 ± 15.00	0.495
CHOL (mmol/L)	4.61 ± 0.75	5.00 ± 1.01	0.375
ESR (mm)	9.67 ± 7.42	8.97 ± 8.22	0.848
CRP (mg/dL)	4.62 ± 5.36	2.58 ± 1.31	0.396
PT (s)	11.70 ± 0.42	11.35 ± 0.64	0.204
PA (%)	102.98 ± 7.89	109.86 ± 11.55	0.175
INR	0.98 ± 0.43	0.94 ± 0.50	0.092
APTT (s)	26.67 ± 3.12	25.17 ± 2.51	0.209
FIB (mg/dL)	306.95 ± 67.93	257.31 ± 68.43	0.114
D-dimer	0.36 ± 0.17	0.42 ± 0.51	0.786

WBC: White blood cell; RBC: Red blood cell; HBG: Hemoglobin; PLT: Platelet; HCT: Hematocrit: ALT: Alanine transaminase; AST: Aspartate transaminase; ALP: Alkaline phosphatase; GLU: Glucose; UREA: Urea nitrogen; CREA: Creatinine; Chol: Cholesterol; ESR: Erythrocyte sedimentation rate; CRP: C-reactive protein; PT: Prothrombin time; PA: Prothrombin activity; INR: International standardized ratio; APTT: Activated partial thromboplastin time; FIB: Fibrinogen.

Table 4 Clinical information of intracranial hemorrhage patients after spinal surgery

No	Gender	Age	Comorbidity	Diagnosis	Procedure	Surgery position	Dura damage	Pedicle screws	Fusion instrument	Clinical manifestations	Brain imaging	Treatment	Outcome (mRS)
1	F	78	CVD	Lumber spinal stenosis (L4/5)	Posterior lumbar spinal fusion, decompression and discectomy	Prone	No	Yes	Yes	Apathy, hemiparalysis 0/5. NIHSS 17	Bilateral parietal and frontal lobe hemorrhage and SAH	Conservative treatment	5
2	M	80	HT	Ossification of thoracic ligamentum flavum (T1-3)	Posterior thoracic spinal fusion, resection of the ligamentum flavum ossification	Prone	No	No	No	Lethargy, aphasia, gaze, quadriplegia 0/5, neck rigidity. NIHSS 34	Left intraventricular hemorrhage and SAH	Conservative treatment	1
3	F	68	HT	Cervical degenerative disc disease (C3-6)	Posterior cervical spinal fusion, laminoplasty procedure	Prone	No	Yes	No	Drowsiness, vomiting, dysarthria, ataxia. NIHSS 5	Bilateral cerebellar hematoma and SAH	Conservative treatment	3
4	F	74	CVD, HT, HLP	Ossification of thoracic ligamentum flavum (T10/11)	Posterior thoracic spinal fusion, laminectomy and resection of ligamentum flavum ossification	Prone	Yes	Yes	Yes	Drowsy, vomiting, aphasia, gaze. NIHSS 10	Right frontal lobe hemorrhage and right cerebellar hematoma	Hematoma evacuation, decompressive craniectomy	5
5	M	68	CVD, HT, DM	Lumber spondylolisthesis L4; degenerative disc disease (L5/S1)	Posterior cervical spinal fusion, decompression and discectomy	Prone	Yes	Yes	Yes	Coma, neck rigidity, quadriplegia 0/5. NIHSS 34.	SAH and intracranial pneumatosis	DSA and conservative treatment	3
6	M	60	HT	Thoracic spondylolisthesis (T12/L1)	Posterior lumbar fusion procedure, resection of ligamentum flavum ossification	Prone	Yes	Yes	Yes	Headache, dysphasia, numbness. NIHSS 2	Bilateral cerebellum hemorrhage	Conservative treatment	2

HT: Hypertension; HLP: Hyperlipidemia; DM: Diabetes mellitus; CVD: Previous cerebral vascular disease; CHD: Coronary heart disease; NIHSS: National Institute of Health stroke scale; mRS: Modified Rankin Scale; SAH: Subarachnoid hemorrhage; DSA: Digital subtraction angiography.