Etiopathogenesis of Traumatic Spinal Epidural Hematoma

Abstract

Spinal epidural hematoma (SEH) is a rare cause of nerve root or cord compression; its pathogenesis is not always clearly recognizable. The aim of this paper was to investigate possible etiopathological factors in a consecutive series of patients affected by traumatic SEH treated at our institution. Seven patients with neurologic impairment due to traumatic SEH were retrospectively analyzed after diagnosis and surgical treatment. Thoracic localization was found in 5 cases, and lumbar and cervical localization were found in 1 patient each. One patient was affected by ankylosing spondylitis and one by diffuse idiopathic skeletal hyperostosis. SEH was associated with spine fractures in 6 cases. Only 2 cases of traumatic SEH resulted from high-energy trauma. All patients underwent surgical decompression within 24 hours after admittance to the hospital. Three patients recovered completely, 3 remained paraplegic, and 1 remained monoplegic. Several concomitant conditions are suggested to be predisposing factors for the development of SEH, although its inherent mechanism is still unknown. Two patients in the present series were affected by rheumatologic disorders, confirming the elevated incidence of hematomas in such patients compared to the normal population. Three very unusual cases of SEH occurred in senile patients affected by osteoporotic fractures. Early diagnosis and urgent decompression of the hematoma remain mandatory.

Posttraumatic Acute Spinal Epidural Hematoma of the Dorsolumbar Region

“…Despite of the fact that there is a large occurrence of spinal injuries, the incidence of SEHs is very low, 1,3-7 probably due to high-energy traumatic events or patients who have predisposing factors (ankylosing spondylitis, rheumatoid arthritis, and psoriatic spondylitis). 3 SEH can be classified as idiopathic, spontaneous or posttraumatic, traumatic lesions (with or without vertebral fractures), 3,[8][9][10] or a complication after mini-invasive spine approach. 11,12 It has been postulated that trauma can lead to rupture of thin-walled epidural veins of Batson's plexus with appearance of EDH.…”

“…17,20,21 The management of SEH depends on the onset (acute vs. chronic), size, extent, and presence of neurological deficits. 3 Surgery is recommended in large-size lesions with neurological deficits to achieve good functional outcome. 1,3,22 In selected cases, a conservative management has also shown to be effective with good outcome.…”

“…3 Surgery is recommended in large-size lesions with neurological deficits to achieve good functional outcome. 1,3,22 In selected cases, a conservative management has also shown to be effective with good outcome. 7,18…”

“…Spinal epidural hematoma (SEH) is an uncommon clinical condition, which is characterized by the collection of blood in the spinal epidural space, leading to spinal cord/roots compression and its potential neurological deficits. [1][2][3][4] We report an uncommon case of posttraumatic dorsolumbar SEH treated surgically with outcome, and discuss the characteristic imaging findings.…”

Acute Spontaneous Spinal Subdural Hematoma: A Case Report

“…Regardless of its cause, bleeding around the spinal cord can produce spinal cord compression, which can present with various symptoms depending on the site and the area involved. Sensory, motor, and autonomic functions of the spinal cord can be affected [ 3 ], and the diagnosis is made accordingly to the patterns of presentation [ 4 ].…”