Treatment strategies and outcomes of spontaneous spinal epidural hematomas

Abstract

Objective To investigate the treatment strategies and neurological outcomes of spontaneous spinal epidural hematomas (SSEH). Methods From June 2004 to March 2016, a total of 42 patients with SSEH were admitted to Department of Neurosurgery, Tianjin Medical University General Hospital and were retrospectively reviewed in this study. All patients were divided into the surgery group (24 cases) and conservative treatment group (18 cases). Based on the time interval from inital symptoms to surgery, the patients in surgery group were further separated into 24 h group. The neurological functions of patients were assessed by the Japanese Orthopedics Association (JOA) scale and American Spinal Injury Association(ASIA) impairment scale. The JOA scores were used to determine the recovery rate of neurological functions. The follow-up period ranged from 4 to 34 months, with an average of 18±6 months. Results There were significant differences in the recovery rate of neurological functions between patients with different ASIA scales either in the surgery group or conservative treatment group (all P 0.05). The neurological function recovery rate in 24 h group (20.0±21.3%) (both P<0.05). Conclusions For patients graded as ASIA scale A, B, C or those with progressive decline in ASIA scale, early surgical treatment should be recommended. For patients of ASIA scale D, E or those with tendency for neurological function recovery within a short term, conservative treatment might be considered. Patients undergoing operations with higher initial ASIA scale and shorter preoperative interval tend to demonstrate better outcomes. Patients undergoing conservative treatment with higher initial ASIA scale seem more likely to achieve good outcomes. Key words: Hematoma, epidural, spinal; Prognosis; Neurosurgical procedures; Conservative management