The medical literature relating to spontaneous cervical epidural hematoma has been reviewed, and two new cases have been added. In total, 43 cases have been analyzed in detail, and the authors present some new hypotheses as to the pathophysiology of this disorder.

One hundred fifty patients underwent spinal surgery for radiculopathy; of these, 120 underwent lumbar surgery and 30 had cervical operations. All of the surgeries were performed to alleviate symptoms due to disc herniation, spondylosis, or both. During the surgical procedures continuous intraoperative electromyograph recordings were taken from the muscle corresponding to the involved nerve root. In baseline recordings taken in the operating room 10 minutes before lumbar surgery, electrical discharge or firing was recorded from the muscle in 18% (22 of 120 patients) of the cases. Once the nerve was decompressed, muscle firing ceased. Electrical discharges were produced with regularity on nerve root retraction. This study concludes that continuous electromyograph monitoring can be accomplished easily and yields valuable information that indicates when the nerve root is adequately decompressed or when undue retraction is exerted on the root.

Four infants underwent craniectomy for craniosynostosis and subsequently developed an expanding cranial defect with herniation of brain. All four had an unrepaired laceration of the dura. The pathophysiology of this entity and of the growing fracture of childhood are discussed, and a unified interpretation of the consequences of unrepaired dural defects is proposed.

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Two patients with posttraumatic osteolytic skull lesions are presented and discussed. One was operated on, and pathological examination confirmed an inflammatory reactive process within the bone lesion.