Prognostic factors and surgical outcomes of spontaneous spinal epidural haematoma: a systematic review and meta-analysis

Vastani, Amisha; Mirza, Asfand Baig; Khoja, Abbas Khizar; Bartram, James; Shaheen, Safwan; Rajkumar, Shivani; China, Musa; Lavrador, José Pedro; Bleil, Cristina; Bell, David A.; Thomas, Nick; Malik, Irfan; Grahovac, Gordan

doi:10.1007/s10143-022-01914-0

Cited by 4 publications

(8 citation statements)

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“…The satisfactory outcome with postoperative modified McCormick Scale grades of I or II in 88% and a functional improvement in 92% of patients in our cohort exceeds the results of a recent meta-analysis by Vastani et al with 66% favorable outcomes [ 29 ]. Crucially, more than a third of the almost 300 patients included in their analysis underwent surgery after more than 24 h after symptom onset as opposed to 12% in our cohort, which is a possible explanation for this difference.…”

Section: Discussioncontrasting

confidence: 71%

“…Due to scarce data on SSEH, there are no management guidelines available [ 11 ]. 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%

“…The importance of time-to-treatment regarding the outcome of SSEH patients is contradictorily reported in two recent meta-analyses [ 3 , 29 ]. While direct neural compression damage is not time-dependent, the potential secondary damage due to venous congestion, ischemia and edema might well be [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…While direct neural compression damage is not time-dependent, the potential secondary damage due to venous congestion, ischemia and edema might well be [ 22 ]. Along with this, many publications discussed a worse long-term outcome in patients with a longer time-to-treatment interval [ 8 , 22 , 25 , 29 , 30 ]. No such correlation could be confirmed in our cohort.…”

Section: Discussionmentioning

confidence: 99%

“…Higher patient age and the use of anticoagulants have been described as risk factors [ 1 , 10 , 15 ]. Typical management of SSEH consists of a (hemi-)laminectomy, laminotomy, or laminoplasty and evacuation of the hematoma [ 29 ].…”

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: 71%