A brief review of literature of spontaneous spinal epidural hematoma in the context of an idiopathic spinal epidural hematoma

Abstract

There is a debate over the origin of bleeding in case of spontaneous spinal epidural hematoma (SSEH). The most widely accepted theory is of venous origin. Since the epidural veins are valveless, there will be increased venous pressure transmitted from intrathoracic and intraabdominal compartments on straining, causing rupture. Another view is that only arterial bleeding can cause rapid compression of spinal cord, since the venous pressure is less than intrathecal pressure. There is a lack of consensus on treatment also. Most of the authors recommend urgent decompressive laminectomy. There is a recent trend towards less invasive options such as partial laminectomy and hemilaminectomy and conservative treatment. Aim of this study is to review the theories about the origin of bleeding in spontaneous spinal epidural hematoma and the methods of treatment. Literature search was done in PubMed for theories of the origin of spontaneous spinal epidural hematoma and the treatment methods. Descriptive analysis was done. A 49-year-old male stoneworker presented with thoracic back pain of acute onset while doing work, followed by weakness of forearm and legs. He had paraplegia with grade 1 power of lower limbs. MRI showed posterior epidural hematoma from C3 to T4. Midline partial laminectomy was done from C5 to T2. Hematoma was evacuated. His power improved over 1 week. Later CT (computed tomography) angiography showed no vascular malformation. Cervical location and rapid development of weakness point towards arterial origin of spontaneous spinal epidural hematoma. Thoracic location and presence of peroperative venous ooze suggest venous origin. Partial or hemilaminectomy is recommended to reduce postoperative instability. Conservative treatment is preferred in case of coagulopathy.