Traumatic spinal subdural hematoma: An illustrative case and series review

Abstract

Traumatic spinal subdural hematomas (SDH) are a rarely reported pathology that can cause permanent neurologic deficit. Evidence is lacking to guide management decisions. We present an illustrative case of traumatic spinal SDH managed conservatively, and systematically review reports of traumatic spinal SDH for variables predictive of a favorable outcome. A systematic review was performed including demographic, clinical, and radiographic variables extracted from case studies. t-tests, Pearson's Chi-squared, and Fischer's Exact test were used to determine group differences in outcome. Fifty-eight reported cases, including our illustrative case, met inclusion criteria. The majority of patients were male (66.7%) with a mean age of 41.3 ± 24.7 years. Most traumas were minor (62.1%) with those presenting after a direct spinal trauma more likely to have a poor outcome. Common presenting symptoms included back pain (N = 45, 77.6%), radiculopathy (N = 33, 56.9%), and subjective weakness (N = 39, 67.2%). Neurologic deficit was present in 51.7% of patients, and in all those with a poor outcome (p < 0.001). Favorable outcome was reported in 47 patients (81.0%) and concomitant cranial SDH was statistically more common in this group (61.7%, p = 0.002). In trauma patients presenting with back pain, weakness, or neurologic deficits, spinal SDH should be considered in the differential. Reassurance and conservative management can often be first-line therapy, and presence of cranial SDH may suggest a favorable outcome. Neurologic deficit and cord compression on presentation are associated with poor outcome and warrant urgent surgical treatment.