{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T06:02:56Z","timestamp":1790229776954,"version":"4.1.0"},"reference-count":10,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Postoperative spinal epidural hematoma (SEH) is a rare but serious complication of spinal surgery. This study explored whether prior percutaneous epidural neuroplasty (PEN) was associated with symptomatic postoperative SEH occurring at a distal level, defined as completely caudal to the surgical decompression site after lumbar spinal surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed 232 consecutive patients who underwent 1- or 2-level lumbar spinal surgery at a single institution between 2020 and 2024. Clinical, surgical, and historical factors were compared between patients who developed symptomatic postoperative SEH requiring revision surgery and those who did not. Due to the low event rate, statistical analysis was restricted to descriptive metrics and Fisher's exact test to explore the association between prior PEN and distal SEH development.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 232 consecutive patients who underwent lumbar spinal surgery were included. Four patients (1.72%) developed postoperative SEH requiring reoperation. Notably, three of these four cases (75.0%) developed hematomas at a distal level entirely caudal to the surgical site. In the primary distal SEH analysis, all three distal cases had a history of prior PEN, compared to 16.2% (37\/229) of patients who did not develop a distal SEH (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.005). Because one cell in the 2\u2009\u00d7\u20092 table was zero, the exact odds ratio was unestimable. In an exploratory univariate analysis using the broader SEH endpoint, prior PEN was more frequent in the SEH group than in the non-SEH group (75.0% vs. 16.2%; Fisher's exact test\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.017; exact odds ratio [OR], 15.49; 95% confidence interval [CI], 1.57\u2013152.99).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this small series, prior PEN demonstrated an exploratory association with symptomatic, distal level postoperative SEH. Given the small number of events and wide confidence intervals, this finding should be interpreted strictly as hypothesis-generating. In symptomatic postoperative patients with a history of caudal epidural interventions, clinicians should maintain awareness and consider extending MRI coverage caudally beyond the index operated level.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1863930","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T05:44:40Z","timestamp":1790228680000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between prior percutaneous epidural neuroplasty and distal postoperative spinal epidural hematoma after lumbar surgery: case series and exploratory analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Tae Hoon","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Nowon Eulji Medical Center","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"In-Suk","family":"Bae","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nowon Eulji Medical Center","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hee In","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nowon Eulji Medical Center","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae Hoon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nowon Eulji Medical Center","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheolsu","family":"Jwa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nowon Eulji Medical Center","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1016\/s1529-9430(02)00535-1","article-title":"Delayed postoperative spinal epidural hematomas","volume":"3","author":"Uribe","year":"2003","journal-title":"Spine J"},{"key":"B2","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1002\/ca.22354","article-title":"Venous drainage of the spine and spinal cord: a comprehensive review of its history, embryology, anatomy, physiology, and pathology","volume":"28","author":"Griessenauer","year":"2015","journal-title":"Clin Anat"},{"key":"B3","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1016\/j.wneu.2020.10.004","article-title":"Revisiting the vertebral venous plexus-A comprehensive review of the literature","volume":"145","author":"Carpenter","year":"2021","journal-title":"World 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outcome","volume":"83","author":"Lawton","year":"1995","journal-title":"J Neurosurg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"177","DOI":"10.36076\/ppj.2004\/7\/177","article-title":"One day lumbar epidural adhesiolysis and hypertonic saline neurolysis in treatment of chronic low back pain: a randomized, double-blind trial","volume":"7","author":"Manchikanti","year":"2004","journal-title":"Pain Physician"},{"key":"B9","doi-asserted-by":"publisher","first-page":"153","DOI":"10.36076\/ppj.2001\/4\/153","article-title":"Role of one day epidural adhesiolysis in management of chronic low back pain: a randomized clinical trial","volume":"4","author":"Manchikanti","year":"2001","journal-title":"Pain Physician"},{"key":"B10","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1007\/s00776-006-1032-y","article-title":"Epidural neuroplasty versus physiotherapy to relieve pain in patients with sciatica: a prospective randomized blinded clinical trial","volume":"11","author":"Veihelmann","year":"2006","journal-title":"J Orthop Sci"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1863930\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T05:44:41Z","timestamp":1790228681000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1863930\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,24]]},"references-count":10,"alternative-id":["10.3389\/fsurg.2026.1863930"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2026.1863930","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,24]]},"article-number":"1863930"}}