Prognostic Factors for Surgically Managed Spontaneous Spinal Epidural Hematoma: A Single-Center Case Series of 18 Patients

Abstract

BACKGROUND:Spontaneous spinal epidural hematoma (SSEH) is a rare pathology, which carries a significant morbidity.OBJECTIVE:To review our institutional experience of surgically managed patients with SSEH, seeking to better understand clinical prognostic factors related to postoperative outcomes and thereby improve counseling of patients before treatment.METHODS:All patients who underwent surgical management of SSEH between September 2011 and 2021. Baseline and postoperative clinical and radiological characteristics are presented, including the American Spinal Injury Association grade (ASIA). Statistical analyses were performed using Stata 13.1.RESULTS:Eighteen patients were identified in total (11 male patients and 7 female patients) with a median age of 59.5 (range 3-83) years. The most common spinal region affected was cervicothoracic (33.3%). Limb weakness (94.4%) and urinary dysfunction (83.3%) represented the most common presenting symptoms. Preoperatively, the presence of spinal cord edema on imaging was associated with worse preoperative Medical Research Council (MRC) grade (P = .033), female sex was associated with preserved saddle sensation (P = .04), and patients receiving antiplatelet medication were associated with a higher risk of preoperative axial back pain (P = .005). Higher postoperative MRC grade was associated with higher preoperative ASIA (P = .012) and MRC grade (P = .005), and preservation of saddle sensation (P = .018). Postoperative improvements in axial back pain were associated with higher preoperative ASIA grade (P = .035) and anticoagulation treatment (P = .029).CONCLUSION:Neurosurgical intervention for SSEH yields positive outcomes and benefits patients. Patients with higher preoperative ASIA, MRC grade, and those presenting with preserved saddle sensation may experience further improved clinical outcomes after intervention.

Thoracolumbar fractures patients undergoing posterior pedicle screw fixation can benefit from drainage

“…Mohamed et al [ 6 ] also concluded that implantation of closed-suction drainage resulted in less formation of epidural fibrosis in patients operated on for unilateral, single-level lumbar disc hernias. Previous studies reported that multilevel procedures, deficient coagulation factors, decreased hemoglobin, advanced age, excessive drinking and previous spinal surgery were identified as risk factors for developing a postoperative epidural hematoma [ 32 – 35 ]. Therefore, these factors should be considered when deciding whether to use a drain tube after pedicle screw fixation.…”

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“…According to research, surgery within 36 h of symptom onset could achieve better outcomes in patients with complete loss of preoperative neurological function [22] . On the other hand, the ratio of recovery to normal can reach 95% for patients with incomplete loss of preoperative neurological function [23] .…”