Skip Hemilaminectomy for Large, Multilevel Spinal Epidural Hematomas: Report of a Series of 11 Patients

OBJECTIVE: We present our experience with a modification of the conventional techniques for the removal of large spinal epidural hematomas (SEHs), based on multilevel "skip hemilaminectomies." METHODS: Eleven patients with SEHs extending over 5 or more spinal segments were treated at our institution via a modified hemilaminectomy technique from 2008 to 2014. This procedure, that we called "skip hemilaminectomy," consists in performing consecutive, alternating, unilateral laminar decompressions at 2-3 levels, followed by sublaminar undercutting, ipsi- and contralateral flavectomy, plus hematoma removal. RESULTS: Complete clot evacuation and full neurologic recovery were always achieved. A short hospital stay, fast postoperative mobilization, a minimized need of analgesic drugs, and no complications were recorded. CONCLUSIONS: In our preliminary experience, skip hemilaminectomy seems to be as safe as more conventional techniques (laminectomy, extended hemilaminectomy) for the removal of large multilevel SEHs, granting full neurologic improvement, short surgical times-even for very large lesions-and no complications at follow-up.