Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Clinical Outcomes of Spontaneous Spinal Epidural Hematoma : A Comparative Study between Conservative and Surgical Treatment

  • Kim, Tackeun (Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Lee, Chang-Hyun (Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Hyun, Seung-Jae (Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Yoon, Sang Hoon (Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Kim, Ki-Jeong (Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Kim, Hyun-Jib (Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine)
  • Received : 2012.06.04
  • Accepted : 2012.12.18
  • Published : 2012.12.28
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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.

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References

  1. Baek BS, Hur JW, Kwon KY, Lee HK : Spontaneous spinal epidural hematoma. J Korean Neurosurg Soc 44 : 40-42, 2008 https://doi.org/10.3340/jkns.2008.44.1.40
  2. Börm W, Mohr K, Hassepass U, Richter HP, Kast E : Spinal hematoma unrelated to previous surgery : analysis of 15 consecutive cases treated in a single institution within a 10-year period. Spine (Phila Pa 1976) 29 : E555-E561, 2004 https://doi.org/10.1097/01.brs.0000147743.46315.8b
  3. Bracken MB, Shepard MJ, Collins WF, Holford TR, Young W, Baskin DS, et al. : A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the Second National Acute Spinal Cord Injury Study. N Engl J Med 322 : 1405-1411, 1990 https://doi.org/10.1056/NEJM199005173222001
  4. Bracken MB, Shepard MJ, Hellenbrand KG, Collins WF, Leo LS, Freeman DF, et al. : Methylprednisolone and neurological function 1 year after spinal cord injury. Results of the National Acute Spinal Cord Injury Study. J Neurosurg 63 : 704-713, 1985 https://doi.org/10.3171/jns.1985.63.5.0704
  5. Clark MA, Paradis NA : Spinal epidural hematoma complicating thrombolytic therapy with tissue plasminogen activator--a case report. J Emerg Med 23 : 247-251, 2002 https://doi.org/10.1016/S0736-4679(02)00546-2
  6. Clemens HJ : [A contribution to the histology of the internal spinal venous plexus]. Z Mikrosk Anat Forsch 67 : 183-189, 1961
  7. Dinsmore AJ, Leonard RB, Manthey D : Spontaneous spinal epidural hematoma : a case report. J Emerg Med 28 : 423-426, 2005 https://doi.org/10.1016/j.jemermed.2004.11.023
  8. Duffill J, Sparrow OC, Millar J, Barker CS : Can spontaneous spinal epidural haematoma be managed safely without operation? A report of four cases. J Neurol Neurosurg Psychiatry 69 : 816-819, 2000 https://doi.org/10.1136/jnnp.69.6.816
  9. García Lopez A, Perez Lara JM, Herrainz Hidalgo R, Puente Gonzalo E : Spinal epidural hematoma following thrombolytic therapy for acute myocardial infarction. Orthopedics 22 : 987-988, 1999
  10. Groen RJ : Non-operative treatment of spontaneous spinal epidural hematomas : a review of the literature and a comparison with operative cases. Acta Neurochir (Wien) 146 : 103-110, 2004 https://doi.org/10.1007/s00701-003-0160-9
  11. Groen RJ, van Alphen HA : Operative treatment of spontaneous spinal epidural hematomas : a study of the factors determining postoperative outcome. Neurosurgery 39 : 494-508; discussion 508-509, 1996
  12. Hentschel SJ, Woolfenden AR, Fairholm DJ : Resolution of spontaneous spinal epidural hematoma without surgery : report of two cases. Spine (Phila Pa 1976) 26 : E525-E527, 2001 https://doi.org/10.1097/00007632-200111150-00025
  13. Heppner PA, Monteith SJ, Law AJ : Spontaneous spinal hematomas and low-molecular-weight heparin. Report of four cases and review of the literature. J Neurosurg Spine 1 : 232-236, 2004 https://doi.org/10.3171/spi.2004.1.2.0232
  14. Heye N : Is there a link between acute spinal epidural hematoma and aspirin? Spine (Phila Pa 1976) 20 : 1931-1932, 1995 https://doi.org/10.1097/00007632-199509000-00017
  15. Holtås S, Heiling M, Lönntoft M : Spontaneous spinal epidural hematoma : findings at MR imaging and clinical correlation. Radiology 199 : 409-413, 1996 https://doi.org/10.1148/radiology.199.2.8668786
  16. Hsieh CF, Lin HJ, Chen KT, Foo NP, Te AL : Acute spontaneous cervical spinal epidural hematoma with hemiparesis as the initial presentation. Eur J Emerg Med 13 : 36-38, 2006 https://doi.org/10.1097/00063110-200602000-00009
  17. Hussenbocus SM, Wilby MJ, Cain C, Hall D : Spontaneous spinal epidural hematoma : a case report and literature review. J Emerg Med 42 : e31-e34, 2012 https://doi.org/10.1016/j.jemermed.2008.08.008
  18. Kirazli Y, Akkoc Y, Kanyilmaz S : Spinal epidural hematoma associated with oral anticoagulation therapy. Am J Phys Med Rehabil 83 : 220-223, 2004 https://doi.org/10.1097/01.PHM.0000107498.91919.44
  19. Kreppel D, Antoniadis G, Seeling W : Spinal hematoma : a literature survey with meta-analysis of 613 patients. Neurosurg Rev 26 : 1-49, 2003 https://doi.org/10.1007/s10143-002-0224-y
  20. Liao CC, Hsieh PC, Lin TK, Lin CL, Lo YL, Lee SC : Surgical treatment of spontaneous spinal epidural hematoma : a 5-year experience. J Neurosurg Spine 11 : 480-486, 2009 https://doi.org/10.3171/2009.4.SPINE08904
  21. Liao CC, Lee ST, Hsu WC, Chen LR, Lui TN, Lee SC : Experience in the surgical management of spontaneous spinal epidural hematoma. J Neurosurg 100 : 38-45, 2004
  22. Liu Z, Jiao Q, Xu J, Wang X, Li S, You C : Spontaneous spinal epidural hematoma : analysis of 23 cases. Surg Neurol 69 : 253-260; discussion 260, 2008 https://doi.org/10.1016/j.surneu.2007.02.019
  23. Matsumura A, Namikawa T, Hashimoto R, Okamoto T, Yanagida I, Hoshi M, et al. : Clinical management for spontaneous spinal epidural hematoma : diagnosis and treatment. Spine J 8 : 534-537, 2008 https://doi.org/10.1016/j.spinee.2007.01.009
  24. Maynard FM Jr, Bracken MB, Creasey G, Ditunno JF Jr, Donovan WH, Ducker TB, et al. : International Standards for Neurological and Functional Classification of Spinal Cord Injury. American Spinal Injury Association. Spinal Cord 35 : 266-274, 1997 https://doi.org/10.1038/sj.sc.3100432
  25. Nawashiro H, Higo R : Contrast enhancement of a hyperacute spontaneous spinal epidural hematoma. AJNR Am J Neuroradiol 22 : 1445, 2001
  26. Pahapill PA, Lownie SP : Conservative treatment of acute spontaneous spinal epidural hematoma. Can J Neurol Sci 25 : 159-163, 1998 https://doi.org/10.1017/S0317167100033795
  27. Schröder J, Palkovic S, Wassmann H : Spontaneous spinal epidural haematoma : a therapeutical challenge? Report of an unusual case. Emerg Med J 22 : 387-388, 2005 https://doi.org/10.1136/emj.2003.014027
  28. Silber SH : Complete nonsurgical resolution of a spontaneous spinal epidural hematoma. Am J Emerg Med 14 : 391-393, 1996
  29. Spengos K, Tsivgoulis G, Zakopoulos N : Could high blood pressure be the cause of acute spontaneous spinal epidural hematoma? Eur J Emerg Med 14 : 59, 2007 https://doi.org/10.1097/01.mej.0000224434.82117.47
  30. Sung JH, Hong JT, Son BC, Lee SW : Clopidogrel-induced spontaneous spinal epidural hematoma. J Korean Med Sci 22 : 577-579, 2007 https://doi.org/10.3346/jkms.2007.22.3.577

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