Idiopathic spinal epidural hematoma (SEH) might be an extremely rare cause of spine compression. It is most common between the fourth and fifth decades of life. It is sporadic in children and is often complicated due to the limitations of a neurologic examination and nonspecific symptoms within the pediatric population. It is typically an isolated event. Only a few cases of relapsing paraparesis due to idiopathic SEH have been mentioned in the literature in adults. We are presenting a rare case of idiopathic SEH in a 1-year-old girl whose diagnosis was deferred after a recent similar history of paraparesis occurred after her scheduled immunization and went on for around 2 weeks, after which the patient recovered completely. However, 2 months later, the patient presented again with paraparesis, and the magnetic resonance imaging revealed an idiopathic SEH. We are detailing this case to raise the plausibility of a remission and relapse phenomenon within the idiopathic SEH presentation that may mimic some neurological disorders of infancy and childhood. The present case was managed surgically and yielded full recovery.

Objectives: Lumbar disk bulge is a common cause of lower back pain. A high percentage of patients improve with conservative management, but unfortunately, some do not. We postulate that an anatomically narrowed lumbar spinal canal might contribute to this variation in response to conservative management. One of the major causes of spinal stenosis is idiopathic congenital-developmental stenosis, and here, we aimed to observe if this non-modifiable risk factor is present among the Saudi population, by analyzing the lower lumbar canal dimensions in computed tomography (CT) scan axial cuts, which might be later a reference and guide in clinical practice. Methods: This retrospective descriptive study included 279 patients aged 20–40years old. We included those who underwent diagnostic CT abdomen and CT lumbar spine with no evidence of lumbar spinal disease or fracture at the level where measures were taken from the axial cuts. Furthermore, exclusion criteria included gross spinal pathologies such as fractures, tumors, deformities, major chronic systemic diseases, congenital anomalies (dwarfism), and metallic artifacts. Results: Of the 279 patients, 137 (49%) were male and 142 (51%) were female. Different measurements were taken from the CT scan of axial cuts of the lower lumbar canal (L3, L4, and L5). The pattern of segmental variation of the lower lumbar vertebral canal was found to be like other populations. In contrast, the mean lower lumbar vertebral canal diameters were characteristically different from the other population (non-compensating). Conclusion: In the Saudi population, anterior-posterior and interpedicular diameters were narrowed (non-compensating). We found a high prevalence (32%) of trefoil configuration in the Saudi population.

Lumbar pedicles are wider than thoracic pedicles and L5 is considered the widest, which requires high-energy trauma to fracture. It is rare to have atraumatic lumbar pedicle fractures. However, it is reported mainly in predisposed patients, like those with contralateral spondylolysis, degenerative spondylolisthesis, previous spine surgery, stressful activities, and metabolic bone disease. We are reporting a rare case of a 37-year-old renal failure male patient who is an office worker who started dialysis only 1 month before the presentation. After a fall from the bed, the patient was found to have four levels pedicle fractures. We aimed to increase the awareness that lumbar pedicle fractures can coexist in patients with renal failure and increase the suspicion index that can promote early diagnosis and effective management.