Background. Symptomatic postoperative spinal epidural hematoma (PSEH) is a devastating complication that could develop after lumbar decompression surgery. PSEH can also develop after biportal endoscopic spine surgery (BESS), one of the recently introduced minimally invasive spine surgery techniques. Gelatin-thrombin matrix sealant (GTMS) is commonly used to prevent PSEH. This study aimed at analyzing the clinical and radiological effects of GTMS use during BESS. Methods. A total of 206 patients with spinal stenosis who underwent decompression by BESS through a posterior interlaminar approach from October 2015 to September 2018 were enrolled in this study. Postoperative magnetic resonance imaging (MRI) was performed in all patients for evaluation of PSEH. Patients in whom GTMS was not used during surgery were assigned to Group A, and those in whom GTMS was used were classified as Group B. In the clinical evaluation, the visual analog scale (VAS) of the leg and back, Oswestry Disability Index (ODI), and modified MacNab criteria were used. The incidence rate and degree of dural compression of PSEH on postoperative MRI were measured. Results. The average age of the patients was (42–89) years. The overall incidence rate of PSEH was 20.9% (43/206). The incidence rates in Groups A and B were 26.4% and 13.6%, respectively, showing a significant difference (). The VAS-leg and ODI improvement was significantly different depending on the intraoperative use of GTMS. However, there was no statistically significant difference between the two groups in terms of the VAS-back improvement. Groups A and B showed “good” and “excellent” rates according to the modified MacNab criteria in 79.4% and 87.6% of patients, respectively, showing statistically significant difference (). In Group A, two patients underwent revision surgery due to PSEH, while none in Group B had such event. Conclusion. Intraoperative use of GTMS during BESS may be related to reduction in the occurrence rate of PSEH. Specifically, patients with GTMS appliance showed marked decrease in the occurrence of PSEH and had better clinical outcomes.

中文翻译：

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明胶-凝血酶基质密封剂 (Floseal®) 在使用双孔内窥镜脊柱手术进行单节段腰椎减压期间对术后脊髓硬膜外血肿的疗效：临床和磁共振图像研究。

背景。有症状的术后脊髓硬膜外血肿 (PSEH) 是腰椎减压手术后可能发生的破坏性并发症。PSEH 也可以在双门内窥镜脊柱手术 (BESS) 后发展，BESS 是最近引入的微创脊柱手术技术之一。明胶-凝血酶基质密封剂 (GTMS) 通常用于预防 PSEH。本研究旨在分析在 BESS 期间使用 GTMS 的临床和放射学影响。方法. 2015 年 10 月至 2018 年 9 月共纳入 206 例经 BESS 后椎板间入路减压的椎管狭窄患者。对所有患者进行术后磁共振成像 (MRI) 以评估 PSEH。术中未使用 GTMS 的患者分为 A 组，使用 GTMS 的患者分为 B 组。 ODI)，并使用了修改后的 MacNab 标准。测量术后MRI上PSEH的发生率和硬脑膜受压程度。结果。患者的平均年龄为（42-89）岁。PSEH的总发病率为20.9%（43/206）。A组和B组的发病率分别为26.4%和13.6%，差异有统计学意义（）。根据术中使用 GTMS，VAS 腿和 ODI 的改善有显着差异。然而，就VAS-back改善而言，两组之间没有统计学上的显着差异。根据改良的 MacNab 标准，A 组和 B 组分别有 79.4% 和 87.6% 的患者表现出“好”和“优”率，差异有统计学意义（）。A组有2例患者因PSEH接受了翻修手术，B组无此事件。结论。BESS 期间术中使用 GTMS 可能与降低 PSEH 的发生率有关。具体而言，GTMS矫治器患者PSEH的发生率显着降低，临床疗效更好。