J Korean Soc Spine Surg.  2013 Dec;20(4):196-200. 10.4184/jkss.2013.20.4.196.

Atraumatic Spinal Interdural Hamatoma: A Case Report

• Im SH
• Kim SW
• Yang BK
• Yi SR
• Ahn YJ
• Jung HJ
• Nam SW
• Kim HS

• KMID: 1896950
• DOI: http://doi.org/10.4184/jkss.2013.20.4.196

Abstract

STUDY DESIGN: A case report.
OBJECTIVES
To investigate the outcomes of recapping laminoplasty for the treatment of atraumatic spinal interdural hematoma. SUMMARY OF LITERATURE REVIEW: There are several causes for a spinal hematoma. The occurrence of spinal hematoma is rare; in particular, the ones arising atraumaticaly are considered extremely rare.
MATERIALS AND METHODS
We studied a 33 year old male patient without any known risk factor. Magnetic resonance image has revealed an intraspinal epidural cyst compressing on the spinal nerve. After performing recapping laminoplasty, followed by partial excision of dura mater and resection of hematoma, we were able to observe another layer of dura mater, confirming the location of hematoma within two epidural layers, i.e., an interdural hematoma.
RESULTS
Performing recapping laminoplasty is a more effective and less invasive procedure for removing cyst than conventionally used laminectomy. Patients were found to have synostosis after three months post-op, and they have exhibited neither lumbosacral pain nor lower limb motor weakness after six months follow-up. There were no recurrences or complications reported on our study.
CONCLUSION
There are a few reported cases of atraumatic spinal interdural hematoma. Our study shows that performing pars osteotomy with recapping laminoplasty yield good clinical outcome for the treatment of atraumatic spinal interdural hematoma.

Keyword

Atraumatic spinal interdural hematoma; Recapping laminoplasty

MeSH Terms

Dura Mater
Follow-Up Studies
Hematoma
Humans
Laminectomy
Lower Extremity
Male
Osteotomy
Recurrence
Risk Factors
Spinal Nerves
Synostosis

Figure

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  Fig. 1. Preoperative MRI shows arachnoid cyst from T11 to L2 in the 33‐year‐old male patient.

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  Fig. 2. (A, B) Intraoperative Gross photo. The incision was made on outer layer of the dura. We observed two layers of dura separated by bloody contents (White arrow being outer interdural layer, asterisk (*) pointing to hematoma, black arrow indicating inner interdural layer subsequent to resection of hematoma) The supraspinous, interspinous ligaments were intact.

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  Fig. 3. Postoperative CT scan. We have used nails in order to fix the posterior structures which had been relocated. Two areas, the first being between superior and inferior spinous processes and the second being adjacent to isthmus, were internally fixated using nails. Both places were undergone osteotomy prior to fixation.

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  Fig. 4. Postoperative MRI (T2,T1 image) and X‐ray shows complete removalof cyst. Postoperative 3months later after recapping laminoplasty shows complete union at the osteotomy and shows no instability.

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