Preoperative neurological status in predicting surgical outcome of spinal epidural hematomas

Foo, Dominic; Rossier, Alain B.

doi:10.1016/0090-3019(81)90178-6

Cited by 271 publications

(183 citation statements)

References 52 publications

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“…The cause of spinal epidural hematoma in 40–50% of cases is not known 2. The causes of SSEH, such as increased bleeding tendency with the use of various medications,3 blood dyscrasia,4 direct or indirect spinal trauma,5 and hypertension,6 have been discussed in published works.…”

Section: Discussionmentioning

confidence: 99%

“…The locations of SSEH appear to have a bimodal distribution with peaks observed at C6 and T12 8. These SSEH lesions are usually located dorsal to the spinal cord 2. Spontaneous spinal epidural hematoma generally develop in individuals between the ages of 50 and 80 years 9…”

Section: Discussionmentioning

confidence: 99%

“…reported that early surgical interventions are associated with better neurological and functional recovery. However, conservative treatment can be used when the neurological deficits improve during the early phase 2. Given that the abasia in case 1 did not improve 24 h after its onset, we performed hematoma removal and decompression by corpectomy from the front of C3–C5.…”

Section: Discussionmentioning

confidence: 99%

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Two cases of spontaneous cervical epidural hematoma without back or neck pain in elderly Japanese men

Hongo

Iseda

Tsuchiya

et al. 2017

Acute Medicine & Surgery

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CasesSpontaneous spinal epidural hematoma (SSEH) is an uncommon disease. Most SSEH cases involve back and/or neck pain. We report the cases of two men who experienced SSEH with dysstasia but without back or neck pain.OutcomesThis study presents two cases involving elderly Japanese men who visited an emergency department because of sudden dysstasia without back or neck pain. The results of the neurological examinations revealed ataxic gait. Cervical spinal epidural hematomas were observed by computed tomography and magnetic resonance imaging. One patient underwent hematoma removal and decompression by corpectomy, whereas the other patient received conservative treatment and observation. The patients were discharged without sequelae.ConclusionSpinal epidural hematomas are difficult to diagnose, and a delayed diagnosis can adversely affect the patient's quality of life. These hematomas should be considered in the differential diagnosis of cerebrovascular diseases.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Two cases of spontaneous cervical epidural hematoma without back or neck pain in elderly Japanese men

Hongo

Iseda

Tsuchiya

et al. 2017

Acute Medicine & Surgery

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“…In a significant number of patients with spontaneous hematoma, the exact cause is not known. 8 Spinal epidural hematoma is a rare complication of epidural anesthesia. [1][2][3] Moen et al 3 found statistically significant differences in the incidence of epidural bleed when epidural injection was given for obstetric procedures (one in 200 000) and for knee replacements (one in 3600).…”

Section: Discussionmentioning

confidence: 99%

Spontaneous complete recovery of paraplegia caused by epidural hematoma complicating epidural anesthesia: a case report and review of literature

2005

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Study design: Case report. Setting: Tertiary referral spinal surgery center in South India. Objectives: To report a patient who developed epidural hematoma following epidural anesthesia causing acute paraplegia. Surgery was avoided due to concomitant gastrointestinal bleeding and poor general condition. Patient showed early signs of recovery with complete resolution of neurological deficits in 12 weeks. Conclusion: Surgery can be avoided in patients who show early signs of neurological recovery following epidural hematoma.

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“…In contrast, the incidence of postoperative SEH that necessitates surgical decompression ranges from 0.1% to 3% [1,2,7,8]. Although rare, these postoperative hematomas can have devastating neurologic consequences and substantial morbidity.…”

Section: Introductionmentioning

confidence: 99%

Case Report: Cauda Equina Syndrome Associated With an Interspinous Device

Limthongkul

Yingsakmongkol

2012

Clinical Orthopaedics &Amp; Related Research

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Background Although postoperative spinal epidural hematoma (SEH) is not uncommon, hematomas that require surgery are rare. Cauda equina syndrome (CES) may be associated with postoperative SEH. In these cases, early recognition and emergency decompression can prevent further damage and better neurologic recovery. Case Description A 41-year-old man underwent twolevel discectomy with insertion of an interspinous spacer at L3-4 and L4-5 because of low back pain and radiculopathy. Eight hours after the operation, the patient developed CES. MRI revealed SEH compressing posteriorly at the L3-4 level. On emergency decompression and hematoma evacuation, the interspinous spacer had obstructed the laminotomy site at L3-4 completely, blocking drainage to the drain. The patient experienced complete neurologic recovery by 2 months followup. Literature Review Many studies report risk factors for SEH. However, postoperative SEH can also be encountered in patients without these risks. One study reported a critical ratio (preoperative versus postoperative cross-sectional area) correlated with postoperative symptoms, especially in those with CES. The propensity to develop CES is likely dependent on a number of patient-specific factors. Clinical Relevance Surgeons should be aware that patients without risk factors may develop acute CES. Wider laminotomy (larger than half of the device size) may help to prevent this complication when one uses the compressible type of device, especially in patients with relatively small lamina.

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Preoperative neurological status in predicting surgical outcome of spinal epidural hematomas

Cited by 271 publications

References 52 publications

Two cases of spontaneous cervical epidural hematoma without back or neck pain in elderly Japanese men

Two cases of spontaneous cervical epidural hematoma without back or neck pain in elderly Japanese men

Spontaneous complete recovery of paraplegia caused by epidural hematoma complicating epidural anesthesia: a case report and review of literature

Case Report: Cauda Equina Syndrome Associated With an Interspinous Device

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