Spinal epidural hematomas: personal experience and literature review of more than 1000 cases

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>The goal of this study was to identify factors that contribute to the formation of acute spinal epidural hematoma (SEH) by correlating etiology, age, site, clinical status, and treatment with immediate results and long-term outcomes.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The authors reviewed their series of 15 patients who had been treated for SEH between 1996 and 2012. In addition, the authors reviewed the relevant international literature from 1869 (when SEH was first described) to 2012, collecting a total of 1010 cases. Statistical analysis was performed in 959 (95%) cases that were considered valid for assessing the incidence of age, sex, site, and clinical status at admission, correlating each of these parameters with the treatment results. Statistical analysis was also performed in 720 (71.3%) cases to study the incidence of etiological factors that favor SEH formation: coagulopathy, trauma, spinal puncture, pregnancy, and multifactorial disorders. The clinical status at admission and long-term outcome were studied for each group. Clinical status was assessed using the Neuro-Grade (NG) scale.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>The mean patient age was 47.97 years (range 0–91 years), and a significant proportion of patients were male (60%, p &lt; 0.001). A bimodal distribution has been reported for age at onset with peaks in the 2nd and 6th decades of life. The cause of the SEH was not reported in 42% of cases. The etiology concerned mainly iatrogenic factors (18%), such as coagulopathy or spinal puncture, rather than noniatrogenic factors (29%), such as genetic or metabolic coagulopathy, trauma, and pregnancy. The etiology was multifactorial in 11.1% of cases. The most common sites for SEH were C-6 (n = 293, 31%) and T-12 (n = 208, 22%), with maximum extension of 6 vertebral bodies in 720 cases (75%). At admission, 806 (84%) cases had moderate neurological impairment (NG 2 or 3), and only lumbar hematoma was associated with a good initial clinical neurological status (NG 0 or 1). Surgery was performed in 767 (80%) cases. Mortality was greater in patients older than 40 years of age (9%; p &lt; 0.01). Sex did not influence any of these data (p &gt; 0.05).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Factors that contribute to the formation of acute SEH are iatrogenic, not iatrogenic, or multifactorial. The treatment of choice is surgery, and the results of treatment are influenced by the patient’s clinical and neurological status at admission, age, and the craniocaudal site.</jats:p></jats:sec>

Haematoma and abscess after neuraxial anaesthesia: a review of 647 cases

“…The majority of patients with spinal haematoma and spinal abscess were surgically managed, which is congruent with the literature. 12 Furthermore, critical factors for recovery are the extent of preoperative neurological deficit and the operative interval, as is reported by other authors. 11 Although we are aware that we cannot advocate certain treatment strategies based on the results of this research, a possibility for conservative treatment seems to be present in certain patients.…”

Diagnóstico diferencial de hernia discal

“…Las causas son múltiples, pudiéndose establecer su etiología en aproximadamente el 70% de los casos 29 . Se han reconocido factores que favorecen la formación de hematomas epidurales, como las coagulopatías, trauma, punción lumbar y embarazo.…”

“…La edad promedio es de aproximadamente 50 años, pero pueden presentarse a cualquier edad, y suelen ser más frecuente en los hombres 29 . Las localizaciones más frecuentes de los hematomas epidurales correspondieron a C6 (31%) y …”

“…D12 (22%), con una extensión máxima de 6 cuerpos vertebrales 29 . Al momento del diagnóstico los pacientes presentan un trastorno neurológico moderado y sólo en algunos casos de hematomas epidurales lumbares los pacientes estaban asintomáticos.…”

Spinal epidural hematoma without significant trauma in children: two case reports and review of the literature

“…In the literature, the term "spontaneous spinal epidural hematoma" was used to describe SEH without clear traumatic etiology. Since this term, however, covers cases of idiopathic SEH, bleeding due to coagulopathy or vascular malformations and hemorrhages after minor trauma, it was recommended to avoid the terminology [1]. In the present article we therefore use the term "SEH without significant trauma".…”