Impact of Paraspinal Muscle Characteristics on the Risk of Symptomatic Epidural Hematoma Following Transforaminal Lumbar Interbody Fusion.

Study DesignRetrospective Study.ObjectiveTo identify clinical risk factors for symptomatic epidural hematoma (SEH) following posterior lumbar decompression and fusion, with a particular focus on paraspinal muscle parameters.MethodsWe retrospectively analyzed data from 105 patients who underwent transforaminal lumbar interbody fusion (TLIF) between January 2016 and January 2025, including 21 patients in the SEH group and 84 in the normal group. General information, surgical-related parameters, routine laboratory parameters, preoperative coagulation-related parameters, spinal imaging-related parameters, and muscle-related parameters were collected. Univariate analysis and binary multivariate logistic regression were performed to identify independent risk factors for SEH.ResultsMultivariate logistic regression identified prolonged thrombin time (OR = 1.780, P = 0.043) and increased multifidus fatty infiltration (FI) (OR = 1.116, P = 0.012) as independent risk factors for SEH following TLIF. Higher bone mineral density (BMD) was a protective factor (OR = 0.527, P = 0.023). No other variables showed significant associations in the regression model.ConclusionPreoperative evaluation of coagulation status, BMD, and paraspinal muscle quality-particularly multifidus FI, is clinically important for predicting and preventing SEH following lumbar spine surgery.