Spontaneous spinal epidural hematoma: Institutional experience

Abstract

Background: Spontaneous Spinal Epidural Haematoma (SSEH) is a rare entity that results from spontaneous, non-traumatic haemorrhage in the spinal epidural space. While erring on the side of caution, few significant clues in the history can lead to an earlier differentiation from more frequently seen pathologies like acute disc herniation and spinal tumors. Once diagnosed, the decision of surgical versus conservative management is entirely clinical and situation-based. In ambiguous scenarios, the study of specific parameters can help to choose one over another.Objective: We are sharing here our experience of six such patients and review relevant literature, mainly focusing on the variables that can help to determine the best therapeutic plan.Material and Methods: We studied the parameters like age, gender, location, number of levels involved, drug history, duration to surgery, American Spinal Injury Association (ASIA) impairment scale grade at presentation, therapeutic plan, and their final ASIA score for six patients of SSEH who presented to our department. We also reviewed the published literature focusing on therapeutic decision-making in SSEH.Results: Five patients were managed surgically and one conservatively. Variables considered while opting for surgical treatment. One patient was managed conservatively based on his improving neurology.Conclusions: Patients with SSEH need to be cautiously selected for surgical or conservative management for their optimal outcome. The study's various variables highlight a few critical concerns while predicting the outcome and guide one to decide a therapeutic plan for this rare pathology.