Diagnosis and treatment of spontaneous spinal epidural hematoma

Abstract

Objective: To investigate the clinical feature, treatment and factors affecting the prognosis of spontaneous spinal epidural hematoma (SSEH). Methods: Analyzed retrospectively the clinical feature, timing of surgical treatment and recovery of neurological function after surgical treatment in 16 patients with SSEH. Evaluated the factors affecting the outcome based on our material and literatures. All the patients with SSEH underwent MR imaging examination. Results: The SSEH were located in the lower cervical (n = 2), cervicothoracic (n=6), thoracic (n = 7), and thoracolumbar (n = 1) regions. On T 1WI, the singal intensity of SSEH was isointense or slightly hyperintense to the spine cord. On T 2WI, SSEH presented hyperintense predominately with focal heterogeneous hypointensity. Neurological outcome was improved in 10 of 12 patients (10/12, 83.33%) treated with surgical management; and neurological function was recovered in 3 of 4 cases (3/4, 75.00%) treated with conservative therapy. Conclusion: MRI is the first choice in the diagnosis of spontaneous spinal epidural hematoma. Early diagnosis and surgical treatment of spontaneous spinal epidural hematoma is the key to neurological function recovery and satisfactory result. The efficacy of spontaneous spinal epidural hematoma operation are mainly related to preoperative deficiency intensity of neurological function and operative time interval. The conservative treatment with close observation may be performed in cases with minimal neurologic deficits, and the injury status determines neurological function recovery.