Neurological severity evaluation using magnetic resonance imaging in acute spontaneous spinal epidural haematomas

Honda, Shintaro; Fujibayashi, Shunsuke; Shimizu, Takayoshi; Tsubouchi, Naoya; Kanba, Yusuke; Sono, Takashi; Kimura, Hiroaki; Odate, Seichi; Onishi, Eijiro; Tamaki, Yasuyuki; Tomizawa, Takuya; Tsutsumi, Ryosuke; Yasura, Ko; Murata, Koichi; Otsuki, Bungo; Matsuda, Shinji

doi:10.1007/s00264-022-05513-y

Cited by 3 publications

(5 citation statements)

References 24 publications

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“…We further could not find a statistical correlation between radiological findings ((I) hematoma localization, (II) hematoma extent, (III) hematoma occupation of the spinal canal and (IV) signs of myelopathy) and clinical outcome. Especially, in contrary to a recent publication by Honda et al, the canal occupation ratio was not shown to be significantly correlated with the clinical outcome [ 12 ]. Moreover, of the 16 patients with radiological signs of myelopathy, ten patients had a favorable outcome.…”

Section: Discussioncontrasting

confidence: 84%

“…Several publications however support an immediate evacuation of an SSEH in symptomatic cases [ 5 , 8 , 22 , 29 , 30 ]. Time-to-treatment, preoperative clinical status, use of anticoagulants, radiologically assessed factors such as the canal occupation ratio as well as the localization and expansion of the hematoma and evidence of myelopathy in the spinal cord on MRI imaging were correlated with clinical outcome [ 1 , 3 , 4 , 8 , 12 , 22 , 25 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…Current evidence on the functional outcomes of SSEH and its determinants is scarce and mainly restricted to retrospective case series with a limited number of patients [ 1 – 10 , 12 – 17 , 19 – 23 , 25 – 32 ].…”

Section: Introductionmentioning

confidence: 99%

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Clinical outcome after surgical management of spontaneous spinal epidural hematoma

Kissling,

Häni,

Schär

et al. 2024

Acta Neurochir

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Purpose Spontaneous spinal epidural hematoma (SSEH) is a rare pathology characterized by a hemorrhage in the spinal epidural space without prior surgical or interventional procedure. Recent literature reported contradictory findings regarding the clinical, radiological and surgical factors determining the outcome, hence the objective of this retrospective analysis was to re-assess these outcome-determining factors. Methods Patients surgically treated for SSEH at our institution from 2010 – 2022 were screened and retrospectively assessed regarding management including the time-to-treatment, the pre-and post-treatment clinical status, the radiological findings as well as other patient-specific parameters. The outcome was assessed using the modified McCormick Scale. Statistical analyses included binary logistic regression and Fisher’s exact test. Results In total, 26 patients (17 men [65%], 9 women [35%], median age 70 years [interquartile range 26.5]) were included for analysis. The SSEHs were located cervically in 31%, cervicothoracically in 42% and thoracically in 27%. Twenty-four patients (92%) improved after surgery. Fifteen patients (58%) had a postoperative modified McCormick Scale grade of I (no residual symptoms) and 8 patients (31%) had a grade of II (mild symptoms). Only 3 (12%) patients remained with a modified McCormick Scale grade of IV or V (severe motor deficits / paraplegic). Neither time-to-treatment, craniocaudal hematoma expansion, axial hematoma occupation of the spinal canal, anticoagulation or antiplatelet drugs, nor the preoperative clinical status were significantly associated with the patients’ outcomes. Conclusion Early surgical evacuation of SSEH generally leads to favorable clinical outcomes. Surgical hematoma evacuation should be indicated in all patients with symptomatic SSEH.

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Section: Discussioncontrasting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

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Clinical outcome after surgical management of spontaneous spinal epidural hematoma

Kissling,

Häni,

Schär

et al. 2024

Acta Neurochir

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“…A subacute hematoma gradually becomes isodense on CT imaging, making it difficult to detect. MRI not only reveals the form of the hematoma but also provides a near-precise assessment of the cord levels it affects [ 24 ]. Moreover, it can provide information about the exact duration of bleeding.…”

Section: Discussionmentioning

confidence: 99%

The Necessity of Extensive Decompression for Spinal Epidural Hematoma: A Case Report and Literature Review

Kahraman,

Senturk

2023

Cureus

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Spinal epidural hematomas (SEHs)are space-occupying lesions that exert pressure on the spinal cord by rapidly accumulating blood between the dura and bone or ligament components. The annual incidence of spontaneous epidural hematoma is estimated to be one in one million. The predominant symptoms are back pain or neurological impairment, including sensory, motor, or autonomic dysfunction of the limbs below the hematoma level. Depending on the level and size of the hematoma and the affected cord, they cause neurological deficits. Neurological deficits are often reversible if diagnosed and treated early with surgical decompression. However, neurological deficits can become permanent if the patient is not operated on timely, and paraplegia or quadriplegia may occur. A 53-year-old man presented to our emergency department with acute-onset back pain and 36-hour-long, rapidly progressive paraparesis of both legs. On T1- and T2-weighted MRI scans, a hyperacute SEH was found as iso/hyperintense and hyperintense, respectively. Immediate decompressive laminectomy from T10 to L2 and hematoma evacuation were performed. It was challenging to remove the hematoma due to its firm consistency. Before performing a bilateral total laminectomy at five levels, the posterior spine was stabilized between T10 and L3 using transpedicular screws. Within 24 hours, the motor function of the lower limbs increased considerably. The patient could sit on a chair because of posterior stability. In addition to the importance of early diagnosis using imaging techniques, planning the extension of SEH surgery is crucial for the patient’s postoperative neurological recovery.

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“…Due to the rarity of SSEH, the etiopathology and underlying mechanisms that cause severe neurological deficits remain unclear. The classical clinical picture encapsulates a surge of back pain, followed by symptoms caused by nerve root or spinal cord compression, resulting in neurological deterioration and neurological emergency [ 12 , 15 , 22 ]. The time frame between signs and symptoms that reflect neurological decline due to neural compression can last minutes to days; thus, a prompt diagnosis might be difficult and often delayed.…”

Section: Introductionmentioning

confidence: 99%

Emergency surgical decompression for spontaneous spinal epidural hematoma in octogenarians: risk factors, clinical outcomes, and complications

et al. 2022

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Purpose Spontaneous spinal epidural hematoma (SSEH) is a rare but disabling disease. Although several cases have been reported in the literature, their treatment remains unclear, especially in patients with advanced age. We, therefore, aimed to describe the clinical outcomes of cervical SSEH in octogenarians with an acute onset of neurological illness undergoing laminectomy. Methods Electronic medical records from a single institution between September 2005 and December 2020 were retrieved. Data on patient demographics, neurological conditions, functional status, surgical characteristics, complications, hospital course, and 90-day mortality were also collected. Results Twenty-two patients aged ≥ 80 years with SSEH undergoing laminectomy were enrolled in this study. The mean Charlson comorbidity index was 9.1 ± 2.0, indicating a poor baseline reserve. Ten individuals (45.5%) were taking anticoagulant agents with a pathologic partial thromboplastin time (PTT) of 46.5 ± 3.4 s. Progressive neurological decline, as defined by the motor score (MS), was observed on admission (63.8 ± 14.0). The in-hospital and 90-day mortality were 4.5% and 9.1%, respectively. Notably, the MS (93.6 ± 8.3) improved significantly after surgery (p < 0.05). Revision surgery was necessary in 5 cases due to recurrent hematoma. Anticoagulant agents and pathological PTT are significant risk factors for its occurrence. Motor weakness and comorbidities were unique risk factors for loss of ambulation. Conclusions Laminectomy and evacuation of the hematoma in octogenarians with progressive neurological decline induce clinical benefits. Emergent surgery seems to be the “state of the art” treatment for SSEH. However, potential complications associated with adverse prognostic factors, such as the use of anticoagulants, should be considered.

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Neurological severity evaluation using magnetic resonance imaging in acute spontaneous spinal epidural haematomas

Cited by 3 publications

References 24 publications

Clinical outcome after surgical management of spontaneous spinal epidural hematoma

Clinical outcome after surgical management of spontaneous spinal epidural hematoma

The Necessity of Extensive Decompression for Spinal Epidural Hematoma: A Case Report and Literature Review

Emergency surgical decompression for spontaneous spinal epidural hematoma in octogenarians: risk factors, clinical outcomes, and complications

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