Post-traumatic Spinal Epidural Hematoma

Abstract

Five patients with vertebral fracture and spinal epidural hematoma (SEH) are described. Another 58-year-old man developed a post-traumatic SEH without bony damage. From the literature, 38 patients (31 male, 4 female, and 3 unknown) were collected. Ankylosing spondylitis or rheumatoid arthritis was noted in 9 of 12 subjects between 50 and 75 years of age. Two groups of patients were identified: Group 1--16 patients with spinal fracture (aged 23 to 63 years), and Group 2--22 patients without spinal fracture (the age was less than 18 years in 12 subjects). In Group 2, a coagulation defect or spinal epidural vascular malformation resulted in a SEH in 6 patients. The preoperative myelopathy was complete in 3 patients each from Group 1 (23.1%) and Group 2 (16.7%). Of the 31 patients operated upon, 9 of the 13 from Group 1 (69.3%) and 6 of the 18 from Group 2 (33.3%) underwent laminectomy within 1 week after the onset of symptoms. Postoperative neurological return was observed in 38.5% (5 of 13) and 88.9% (16 of 18) of these two groups of patients, respectively. Post-traumatic SEHs, predominant in the male population, are often associated with vertebral disease in elderly patients. In the very young patient, there is usually no fracture/dislocation of the spine. A predisposing lesion may be present when spinal fracture is not evident. The prognosis after surgical intervention is better in patients without spinal fracture than in those with vertebral damage, probably because of less contusion to the spinal cord and the presence of very young subjects in the former group of patients.

Posterior fixation of subaxial cervical spine fractures in patients with ankylosing spondylitis

“…Imaging problems, due to the deformity and osteoporosis, and the fact that these fractures often occur after minimal trauma, frequently delay the diagnosis [4,22,25,26]. Patients with cervical spine fractures and ankylosing spondylitis have a high incidence of neurological injuries at admission and appear to be more susceptible to develop large epidural hematomas [4,10,13,15,35]. Rehabilitation is also a problematic field-increased difficulty in rehabilitating cord-injured patients with pre-existing ankylosing spondylitis has been demonstrated [31].…”

Delayed traumatic spinal epidural hematoma with spontaneous resolution of symptoms

“…The majority of these injuries were considered spontaneous and were associated with coagulopathy, vascular malformations, neoplasm, minor trauma, and pregnancy. Post-traumatic spinal epidural hematoma is relatively uncommon (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). We report a case of a delayed traumatic SEH in a patient injured while driving a United States Army Light Armored Vehicle.…”

Traumatic spinal epidural hematoma without bone disruption

“…TSEH: Traumatic spinal epidural hematoma . MRI: Magnetic resonance imaging Traumatic spinal epidural hematoma (TSEH) is an uncommon disorder usually associated with spinal fracture or dislocation [3]. TSEH without bone disruption is rare and has been reported in only 18 children [1][2][3][4][5][6][7].…”

“…However, because vertebral damage is often absent in children with spinal cord trauma due to the greater elasticity of the spinal column [3,5], minor trauma can cause SEH without bone disruption in these patients. TSEH also develops after minor trauma in patients with coagulopathy or spinal vascular malformation [3]. The fact that our patient had no coagulopathy or spinal vascular malformation suggested that minor back trauma itself can contribute to the development of SEH.…”

“…Outcome after surgical treatment of TSEH varies with the length of interval between the onset of paresis and operation, the severity of the preoperative neurological status, and the age of the patient [2,3]. Although TSEH patients without bone disruption generally exhibit better neurological outcomes after surgical treatment, likely because of less contusion to the spinal cord [3], some patients have developed neurological deficits because of delayed diagnosis and/or delayed surgical treatment [6]. Spinal MRI should be performed as early as possible when paresis or sensory abnormalities occur in patients with back trauma, even if spinal bone lesions are absent.…”