Spontaneous spinal epidural hematoma

Abstract

Spontaneous spinal epidural hematoma (SSEH) is a rare emergent condition. It may result in paraplegia, quadriplegia and even death. Prompt diagnosis and emergent decompressive surgical management have been recommended to prevent mortality and morbidity. Although several factors have been associated with prognosis, controversy remains, partly due to its rarity. Thus, the history, clinical presentation, physical examination findings, radiological images, and surgical and pathological records of 30 patients with SSEH (21 male, nine female [sex ratio of 2.3:1], average age of 35 years) treated between January 2002 and September 2010 have been reviewed. The association of age, sex, hypertension, vascular malformation, vertebral level, position and extension of the hematoma, progression interval, operative interval, spinal cord edema, and preoperative neurological condition with the prognosis is discussed. The outcome was better for patients with incomplete neurological deficit ( p = 0.001), lesions extending <4 vertebral segments ( p = 0.026), and lesions in the thoracolumbar and lumbar region. A shorter progression interval often led to a less favorable prognosis ( p = 0.017). Patients with spinal cord edema experienced a worse preoperative neurological deficit ( p = 0.005) and a worse outcome ( p = 0.000). Patients with a progression interval ⩽12 hours presented with a worse preoperative neurological deficit ( p = 0.026). Early surgical intervention to evacuate the hematoma remains the main treatment for most symptomatic patients. Conservative treatment may be used only for those in a good preoperative neurological condition. Prognosis is associated with the preoperative neurological condition, progression internal, spinal cord edema, and extension and vertebral level of the SSEH. Patients with SSEH in the cervical or cervicothoracic region with a complete preoperative motor deficit have a higher mortality rate.