Simultaneous intracranial and spinal subdural hematomas are extremely rare. In most cases, they are attributed to major or minor trauma and iatrogenic causes, such as those resulting from spinal puncture. To the best of the authors' knowledge, there has been only two reports of spontaneous concomitant intracranial and spinal subdural hematomas in a patient receiving anticoagulant therapy who had an absence of evident trauma history. We report on a case of spontaneous concomitant intracranial and spinal subdural hematomas that occurred in association with anticoagulant therapy and present a review of the relevant literature.

Objective: The purpose of this study was to determine whether screw fixation without bone fusion in patients with a low lumbar burst fracture has satisfactory outcomes. Methods: Twelve patients that underwent screw fixation without bone fusion for a low lumbar burst fracture (L3-5) between 2006 and 2009, were included in this study. Motor power was intact despite severe canal compromise in all. Surgical procedures included postural reduction for 2 days and screw fixation without bone fusion. Imaging and clinical findings, including level of the involved vertebra, vertebral height, canal compromise, clinical outcomes, and related complications were analyzed. Results: Mean follow-up was 23.1±11.0 months. Mean pain score (visual analogue scale) prior to surgery was 7.8±2.0 and this decreased to 1.8±1.0 at final follow-up. In 5 patients, open screw fixation by midline skin incision was performed and 7 patients underwent percutaneous screw fixation at one level above, one level below the fractured vertebra and fractured level itself. The proportion of canal compromise at the fractured level improved significantly from 60% to 30% at final follow-up (p＜0.001). Mean preoperative vertebral height loss was 31.0%, and improved to 20.5% at final follow-up, though this improvement was not statistically significant (p＜0.001). No neurological aggravation related to neural injury was observed. Conclusion: Short segment pedicle screw fixation without bone fusion can be an effective and safe operative technique for the management of selected low lumbar burst fractures.