Surgical treatment of spontaneous spinal epidural hematoma: a 5-year experience

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Spontaneous spinal epidural hematoma (SSEH) is a rare disease. The goal of this study was to clarify the treatment results and management options in SSEH.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Patients with SSEH who were surgically treated in the authors' center between June 2003 and June 2008 were included in this study. Patients were treated as early as possible if their neurological deficits were incomplete or had been complete for 12 hours or less. The patients were assigned to 1 of 2 groups based on completeness of preoperative cord dysfunction (complete vs incomplete deficit). Surgical outcomes of the 2 groups were compared by functional performance, coded as Nurick grades at 1, 3, and 6 months after the operation. Also compared were duration of hospital stay and the number of days needed to regain the ability to function independently (defined as Nurick Grades 1 and 2) after the operation.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>There were 17 patients (7 female and 10 male) with pathologically confirmed SSEH. Coagulopathy, greater size (length) of SSEH, and preoperative complete spinal dysfunction were found to contribute to poor postoperative functional recovery (p &lt; 0.05). Patients with incomplete preoperative deficits (ASIA Impairment Scale Grades B, C, and D) were able to achieve functional independent recovery within a month after surgery and had significantly better outcomes (lower Nurick grades) at 1, 3, and 6 months postoperatively than those with complete deficits (p &lt; 0.001, p = 0.027, and p = 0.027, respectively). Median time to independent functional recovery and median length of hospital stay were significantly shorter in patients with incomplete preoperative deficits than in those with complete deficits (6 vs 110 and 9 vs 58 days, respectively; both p &lt; 0.001).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Impaired preoperative hemostasis contributes to larger size of SSEH, high probability of postoperative recurrence of spinal epidural hematoma, and poor functional recovery following surgical evacuation. Incomplete spinal cord dysfunction before surgery predicts good outcome and warrants emergent evacuation of SSEH especially in the cervical and thoracic regions, where the clots are located in proximity to the spinal cord.</jats:p></jats:sec>

Spinal Epidural Hematoma Presenting with Paraplegia: Two Different Etiologies and Treatment Approaches

“…Ayırıcı tanıda intervertebral disk herniasyonu, spinal kord iskemisi, transvers miyelit, spinal epidural tümör veya apse, spondilit ve aortik anevrizma rüptürü düşünülmelidir (8). Patogenez tam olarak aydınlatılamasa da, suçlanan faktörler; spinal epidural boşluktaki epidural venöz pleksusun kapaklarının olmaması ve göğüs ile karın boşluğundaki ani basınç artması ile damar rüptürüne bağlı gelişen kanamadır (9). Eğer nörolojik tabloda hızlı bir ilerleme varsa kanama kaynağının arteryel kaynaklı olabileceği düşünülebilir (10).…”

Acute Quadriplegia Caused by Idiopathic Spontaneous Epidural Haematoma in Young Adult-Case Report and Review of Literature

“…Patients with elevated surgical risk, heavy cardiovascular disease, irreversible spinal cord lesion or severe systemic disease should be treated conservatively at first [15,31,32]. Contrary to the previous sentence recent paper claims that the outcomes of conservative approach are very poor, especially in the cervical leveled lesions [30,33]. Post-OP mortality of SSEH ranges from 3% to 6% [1][2][3].…”

“…Post-OP mortality of SSEH ranges from 3% to 6% [1][2][3]. Size and location of hematoma, pre-operative neurological deficits and timing of the surgical decompression is directly connected to the prognosis [23,30,33].…”

Prediction of neurological recovery in spontaneous spinal epidural hematoma using apparent diffusion coefficient values

“…Moreover, in case of the occurrence of complete dysfunction, functional recovery can be expected if decompression is performed early. 2,19 In one of these studies, 65.9% of patients who received surgical treatment within 12 h of the onset of symptoms recovered completely, while the complete recovery rate decreased to 29.1% if surgical decompression was performed from 13 h to 1week. 3 To date, we have relied on neurological examination and the duration of the symptoms to estimate the irreversibility of spinal cord damage in SSEH.…”

“…They include size or location of the hematoma, speed of hematoma accumulation, neurological grade on admission and timing of the surgery. 2,19,20 For better functional recovery, these studies commonly propose prompt surgical evacuation of the epidural hematoma before complete or irreversible damage occurs in the spinal cord parenchyma. Moreover, in case of the occurrence of complete dysfunction, functional recovery can be expected if decompression is performed early.…”