Non-operative treatment of spontaneous spinal epidural hematomas: a review of the literature and a comparison with operative cases

Abstract

The recent increase of publications of SSEH(cons) has to be explained by the introduction of MRI in daily medical practice. As a result, more patients with a mild or benign clinical course are being diagnosed. In earlier times those patients would have escaped medical attention. The mean length of the hematoma in SSEH(cons) appears to be significantly higher compared to SSEH(oper). This suggests that spontaneous regression of neurological symptoms may result from decompression of the neural structures by spreading of the (liquid) hematoma along the spinal epidural space in the early stages after haemorrhage. Based on the present review, there appear to be no factors which promote conservative treatment in SSEH. In the majority of cases with SSEH, the mainstay of treatment will remain surgical decompression of the neural structures and removal of the hematoma. The decision for conservative treatment has to be based on the severity of the neurological deficit and on the clinical course. Retrospectively, the length of the hematoma seems to give a clue to the spontaneous recovery which occurs in some cases of SSEH. Nevertheless, hematoma-length can not be used as a guide to treatment.

Surgical management of spontaneous spinal epidural hematoma

“…In addition, age and gender did not show any correlation with the postoperative neurological outcomes, which was the same as other authors' results [7,11].…”

“…Groen et al have claimed that SSEH occurred mainly in the cervicothoracic or thoracolumbar region [8,11,12]. Foo et al [9] and Major et al [31] described that surgical outcomes were more favorable in the lumbosacral region than in the thoracic region, and Fukui et al [10] reported that if the hematoma has a cervical or cervicothoracic localization, spontaneous recovery is possible without a surgical operation.…”

Delayed spinal epidural hematoma following spinal anesthesia, far from needle puncture site

“…The majority of patients treated conservatively had already shown improvement during initial evaluation. 5 …”

Chronic pure radiculopathy in patient with organizing epidural hematoma around C8 nerve root

“…Groen [9] reported that 9% of a series of 64 SCEH cases treated conservatively presented an isolated radicular compromise; only one of his cases was located on the cervicothoracic spine.…”