J Korean Neurosurg Soc.  2012 Dec;52(6):523-527. 10.3340/jkns.2012.52.6.523.

Clinical Outcomes of Spontaneous Spinal Epidural Hematoma : A Comparative Study between Conservative and Surgical Treatment

• Kim T
• Lee CH
• Hyun SJ
• Yoon SH
• Kim KJ
• Kim HJ

• KMID: 1426261
• DOI: http://doi.org/10.3340/jkns.2012.52.6.523

Abstract

OBJECTIVE
The incidence of spontaneous spinal epidural hematoma (SSEH) is rare. Patients with SSEH, however, present disabling neurologic deficits. Clinical outcomes are variable among patients. To evaluate the adequate treatment method according to initial patients' neurological status and clinical outcome with comparison of variables affecting the clinical outcome.
METHODS
We included 15 patients suffered from SSEH. Patients were divided into two groups by treatment method. Initial neurological status and clinical outcomes were assessed by the American Spinal Injury Association (ASIA) impairment scale. Also sagittal hematoma location and length of involved segment was analyzed with magnetic resonance images. Other factors such as age, sex, premorbid medication and duration of hospital stay were reviewed with medical records. Nonparametric statistical analysis and subgroup analysis were performed to overcome small sample size.
RESULTS
Among fifteen patients, ten patients underwent decompressive surgery, and remaining five were treated with conservative therapy. Patients showed no different initial neurologic status between treatment groups. Initial neurologic status was strongly associated with neurological recovery (p=0.030). Factors that did not seem to affect clinical outcomes included : age, sex, length of the involved spinal segment, sagittal location of hematoma, premorbid medication of antiplatelets or anticoagulants, and treatment methods.
CONCLUSION
For the management of SSEH, early decompressive surgery is usually recommended. However, conservative management can also be feasible in selective patients who present neurologic status as ASIA scale E or in whom early recovery of function has initiated with ASIA scale C or D.

Keyword

Spinal epidural hematoma; Surgery; Conservative management; Outcome

MeSH Terms

Anticoagulants
Asia
Hematoma
Hematoma, Epidural, Spinal
Humans
Incidence
Length of Stay
Magnetic Resonance Spectroscopy
Medical Records
Neurologic Manifestations
Recovery of Function
Spinal Injuries
Anticoagulants

Figure

• 

  Fig. 1 T2 oblique sagittal (A) and axial (B) MRI of a patient treated with conservative management. T2 oblique sagittal (C) and axial (D) magnetic resonance images after a 1-month follow-up demonstrate the disappearance of the epidural hematoma.

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