Clinical study of acute spinal spontaneous hematoma

Abstract

Objective To evaluate the etiology, pathogenesis, clinical manifestation, imaging features, treatments and factors related to prognosis of acute spinal spontaneous hematoma. Methods The clinical data of 38 patients with acute spinal hematoma treated in our hospital from 2011 till now were analyzed retrospectively. Duration of follow-up was 6 months. The factors influencing the prognosis were analyzed. Results Acute epidural hematomas (n=29) were much more common than subdural (n=5), subarachnoid (n=1) and intramedullary (n=3). Most hematomas were located in the cervical and thoracic vertebra regions. The etiology of acute spinal spontaneous hematoma was unknown in most patients. Twenty-nine patients were dealt with surgical intervention and 9 patients were treated conservatively. After 6-month follow up, recovery rate measured by JOA score in patients of spinal injury ASIA level A and B was (51.26±38.97), and level C, D and E was (80.33±25.83), P<0.05. Recovery rate in patients with hematoma discovered in less then 24 hours treated with surgical decompression was(64.79±36.10), and that in those with hematoma present over 24 hours was (34.54±30.17), P<0.05. Conclusions Acute spinal hematoma always caused by unknown etiology, and usually manifests itself in a sudden onset of pain and neurological deficits. The early diagnosis mainly depends on MRI. Patients presenting with severe neurologic dysfunction or showing signs of progressive deficit should have immediate surgical intervention. The status of neurological deficits before surgery and the length of interval between onset and surgical intervention are associated with recovery. Key words: Spontaneous hematoma; Intra-spinal; Magnetic resonance imaging; Neurological deficits; Emergency surgery; Laminectomy; Conservative treatment; Prognosis