Surgical management of spinal epidural hematoma: relationship between surgical timing and neurological outcome

Michael T. Lawton Divisions of Neurological Surgery and Neuroradiology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and Department of Mathematics, Arizona State University, Tempe, Arizona

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 M.D.
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Randall W. Porter Divisions of Neurological Surgery and Neuroradiology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and Department of Mathematics, Arizona State University, Tempe, Arizona

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Joseph E. Heiserman Divisions of Neurological Surgery and Neuroradiology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and Department of Mathematics, Arizona State University, Tempe, Arizona

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Ronald Jacobowitz Divisions of Neurological Surgery and Neuroradiology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and Department of Mathematics, Arizona State University, Tempe, Arizona

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Volker K. H. Sonntag Divisions of Neurological Surgery and Neuroradiology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and Department of Mathematics, Arizona State University, Tempe, Arizona

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Curtis A. Dickman Divisions of Neurological Surgery and Neuroradiology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and Department of Mathematics, Arizona State University, Tempe, Arizona

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Volume 83: Issue 1
DOI link:
https://doi.org/10.3171/jns.1995.83.1.0001
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✓ Thirty patients were treated surgically for spinal epidural hematoma (SEH). Twelve of these cases resulted from spinal surgery, seven from epidural catheters, four from vascular lesions, three from anticoagulation medications, two from trauma, and two from spontaneous causes. Pain was the predominant initial symptom, and all patients developed neurological deficits. Eight patients had complete motor and sensory loss (Frankel Grade A); six had complete motor loss but some sensation preserved (Frankel Grade B); and 16 had incomplete loss of motor function (10 patients Frankel Grade C and six patients Frankel Grade D). The average interval from onset of initial symptom to maximum neurological deficit was 13 hours, and the average interval from onset of symptom to surgery was 23 hours. Surgical evacuation of the hematoma was performed in all patients; 26 of these improved; four remained unchanged, and no patients worsened (mean follow up 11 months). Complete recovery (Frankel Grade E) was observed in 43% of the patients and functional recovery (Frankel Grades D or E) was observed in 87%. One postoperative death occurred from a pulmonary embolus (surgical mortality 3%). Preoperative neurological status correlated with outcome; 83% of Frankel Grade D patients recovered completely compared to 25% of Frankel Grade A patients. The rapidity of surgical intervention also correlated with outcome; greater neurological recovery occurred as the interval from symptom onset to surgery decreased. Patients taken to surgery within 12 hours had better neurological outcomes than patients with identical preoperative Frankel grades whose surgery was delayed beyond 12 hours. This large series of SEH demonstrates that rapid diagnosis and emergency surgical treatment maximize neurological recovery. However, patients with complete neurological lesions or long-standing compression can improve substantially with surgery.

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Contributor Notes

Address reprint requests to: Curtis A. Dickman, M.D., c/o Editorial Office, Barrow Neurological Institute, 350 West Thomas Road, Phoenix, Arizona 85013–4496.
Address for Dr. Jacobowitz: Arizona State University, Tempe, Arizona.
  • 1.

    Avrahami E, , Tadmor R, & Ram Z, et al: MR demonstration of spontaneous acute epidural hematoma of the thoracic spine. Neuroradiology 31:89–92, 1989 Avrahami E, Tadmor R, Ram Z, et al: MR demonstration of spontaneous acute epidural hematoma of the thoracic spine. Neuroradiology 31:89–92, 1989

    • Search Google Scholar
    • Export Citation
  • 2.

    Baron HC, , LaRaja RD, & Rossi G, et al: Continuous epidural analgesia in the heparinized vascular surgical patient: a retrospective review of 912 patients. J Vasc Surg 6:144–146, 1987 Baron HC, LaRaja RD, Rossi G, et al: Continuous epidural analgesia in the heparinized vascular surgical patient: a retrospective review of 912 patients. J Vasc Surg 6:144–146, 1987

    • Search Google Scholar
    • Export Citation
  • 3.

    Beatty RM, & Winston KR: Spontaneous cervical epidural hematoma. A consideration of etiology. J Neurosurg 61:143–148, 1984 Beatty RM, Winston KR: Spontaneous cervical epidural hematoma. A consideration of etiology. J Neurosurg 61:143–148, 1984

    • Search Google Scholar
    • Export Citation
  • 4.

    Bernsen PLJA, , Haan J, & Vielvoye GJ, et al: Spinal epidural hematoma visualized by magnetic resonance imaging. Neuroradiology 30:280, 1988 Bernsen PLJA, Haan J, Vielvoye GJ, et al: Spinal epidural hematoma visualized by magnetic resonance imaging. Neuroradiology 30:280, 1988

    • Search Google Scholar
    • Export Citation
  • 5.

    Bruyn GW, & Bosma NJ: Spinal extradural hematoma, in Vinken PJ, & Bruyn GW (eds): Handbook of Clinical Neurology. Amsterdam: North-Holland Publishing, 1976, Vol 26, pp 1–30 Bruyn GW, Bosma NJ: Spinal extradural hematoma, in Vinken PJ, Bruyn GW (eds): Handbook of Clinical Neurology. Amsterdam: North-Holland Publishing, 1976, Vol 26, pp 1–30

    • Search Google Scholar
    • Export Citation
  • 6.

    Cooper DW: Spontaneous spinal epidural hematoma. Case report. J Neurosurg 26:343–345, 1967 Cooper DW: Spontaneous spinal epidural hematoma. Case report. J Neurosurg 26:343–345, 1967

    • Search Google Scholar
    • Export Citation
  • 7.

    Dickman CA, , Shedd SA, & Spetzler RF, et al: Spinal epidural hematoma associated with epidural anesthesia: complications of systemic heparinization in patients receiving peripheral vascular thrombolytic therapy. Anesthesiology 72:947–950, 1990 Dickman CA, Shedd SA, Spetzler RF, et al: Spinal epidural hematoma associated with epidural anesthesia: complications of systemic heparinization in patients receiving peripheral vascular thrombolytic therapy. Anesthesiology 72:947–950, 1990

    • Search Google Scholar
    • Export Citation
  • 8.

    Dolan EJ, , Tator CH, & Endrenyi L: The value of decompression for acute experimental spinal cord compression injury. J Neurosurg 53:749–755, 1980 Dolan EJ, Tator CH, Endrenyi L: The value of decompression for acute experimental spinal cord compression injury. J Neurosurg 53:749–755, 1980

    • Search Google Scholar
    • Export Citation
  • 9.

    Foo D, & Rossier AB: Preoperative neurological status in predicting surgical outcome of spinal epidural hematomas. Surg Neurol 15:389–401, 1981 Foo D, Rossier AB: Preoperative neurological status in predicting surgical outcome of spinal epidural hematomas. Surg Neurol 15:389–401, 1981

    • Search Google Scholar
    • Export Citation
  • 10.

    Frankel HL, , Hancock DO, & Hyslop G, et al: The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. Part I. Paraplegia 7:179–192, 1969 Frankel HL, Hancock DO, Hyslop G, et al: The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. Part I. Paraplegia 7:179–192, 1969

    • Search Google Scholar
    • Export Citation
  • 11.

    Galzio RJ, , Zenobii M, & D'Ecclesia G: Spontaneous spinal epidural hematoma: report of a case with complete recovery. Surg Neurol 14:263–265, 1980 Galzio RJ, Zenobii M, D'Ecclesia G: Spontaneous spinal epidural hematoma: report of a case with complete recovery. Surg Neurol 14:263–265, 1980

    • Search Google Scholar
    • Export Citation
  • 12.

    Grollmus J, & Hoff J: Spontaneous spinal epidural haemorrhage: good results after early treatment. J Neurol Neurosurg Psychiatry 38:89–90, 1975 Grollmus J, Hoff J: Spontaneous spinal epidural haemorrhage: good results after early treatment. J Neurol Neurosurg Psychiatry 38:89–90, 1975

    • Search Google Scholar
    • Export Citation
  • 13.

    Gundry CR, & Heithoff KB: Epidural hematoma of the lumbar spine: 18 surgically confirmed cases. Radiology 187:427–431, 1993 Gundry CR, Heithoff KB: Epidural hematoma of the lumbar spine: 18 surgically confirmed cases. Radiology 187:427–431, 1993

    • Search Google Scholar
    • Export Citation
  • 14.

    Harrison BM, & McDonald WI: Remyelination after transient experimental compression of the spinal cord. Ann Neurol 1:542–551, 1977 Harrison BM, McDonald WI: Remyelination after transient experimental compression of the spinal cord. Ann Neurol 1:542–551, 1977

    • Search Google Scholar
    • Export Citation
  • 15.

    Jackson R: Case of spinal apoplexy. Lancet 2:538–539, 1869 Jackson R: Case of spinal apoplexy. Lancet 2:538–539, 1869

  • 16.

    Jonas AF: Spinal fractures. Opinion based on observations of sixteen operations. JAMA 57:859–865, 1911 Jonas AF: Spinal fractures. Opinion based on observations of sixteen operations. JAMA 57:859–865, 1911

    • Search Google Scholar
    • Export Citation
  • 17.

    Kulkarni MV, , McArdle CB, & Kopanicky D, et al: Acute spinal cord injury: MR imaging at 1.5 T. Radiology 164:837–843, 1987 Kulkarni MV, McArdle CB, Kopanicky D, et al: Acute spinal cord injury: MR imaging at 1.5 T. Radiology 164:837–843, 1987

    • Search Google Scholar
    • Export Citation
  • 18.

    Lanzieri CF, , Sacher M, & Solodnik P, et al: CT myelography of spontaneous spinal epidural hematoma. J Comput Assist Tomogr 9:393–394, 1985 Lanzieri CF, Sacher M, Solodnik P, et al: CT myelography of spontaneous spinal epidural hematoma. J Comput Assist Tomogr 9:393–394, 1985

    • Search Google Scholar
    • Export Citation
  • 19.

    Locke GE, , Giorgio AJ, & Biggers SL, et al: Acute spinal epidural hematoma secondary to aspirin-induced prolonged bleeding. Surg Neurol 5:293–296, 1976 Locke GE, Giorgio AJ, Biggers SL, et al: Acute spinal epidural hematoma secondary to aspirin-induced prolonged bleeding. Surg Neurol 5:293–296, 1976

    • Search Google Scholar
    • Export Citation
  • 20.

    Mattle H, , Seib JP, & Rohner M, et al: Nontraumatic spinal epidural and subdural hematomas. Neurology 37:1351–1356, 1987 Mattle H, Seib JP, Rohner M, et al: Nontraumatic spinal epidural and subdural hematomas. Neurology 37:1351–1356, 1987

    • Search Google Scholar
    • Export Citation
  • 21.

    McQuarrie IG: Recovery from paraplegia caused by spontaneous spinal epidural hematoma. Neurology 28:224–228, 1978 McQuarrie IG: Recovery from paraplegia caused by spontaneous spinal epidural hematoma. Neurology 28:224–228, 1978

    • Search Google Scholar
    • Export Citation
  • 22.

    Müller H, , Schramm J, & Roggendorf W, et al: Vascular malformations as a cause of spontaneous spinal epidural haematoma. Acta Neurochir 62:297–305, 1982 Müller H, Schramm J, Roggendorf W, et al: Vascular malformations as a cause of spontaneous spinal epidural haematoma. Acta Neurochir 62:297–305, 1982

    • Search Google Scholar
    • Export Citation
  • 23.

    Odoom JA, & Sih IL: Epidural analgesia and anticoagulant therapy: experience with one thousand cases of continuous epidurals. Anaesthesia 38:254–259, 1983 Odoom JA, Sih IL: Epidural analgesia and anticoagulant therapy: experience with one thousand cases of continuous epidurals. Anaesthesia 38:254–259, 1983

    • Search Google Scholar
    • Export Citation
  • 24.

    Pan G, , Kulkarni M, & MacDougall DJ, et al: Traumatic epidural hematoma of the cerebral spine: diagnosis with magnetic resonance imaging. J Neurosurg 68:798–801, 1988 Pan G, Kulkarni M, MacDougall DJ, et al: Traumatic epidural hematoma of the cerebral spine: diagnosis with magnetic resonance imaging. J Neurosurg 68:798–801, 1988

    • Search Google Scholar
    • Export Citation
  • 25.

    Rao TLK, & El-Etr AA: Anticoagulation following placement of epidural and subarachnoid catheters: an evaluation of neurologic sequelae. Anesthesiology 55:618–620, 1981 Rao TLK, El-Etr AA: Anticoagulation following placement of epidural and subarachnoid catheters: an evaluation of neurologic sequelae. Anesthesiology 55:618–620, 1981

    • Search Google Scholar
    • Export Citation
  • 26.

    Rothfus WE, , Chedid MK, & Deeb ZL, et al: MR imaging in the diagnosis of spontaneous spinal epidural hematomas. J Comput Assist Tomogr 11:851–854, 1987 Rothfus WE, Chedid MK, Deeb ZL, et al: MR imaging in the diagnosis of spontaneous spinal epidural hematomas. J Comput Assist Tomogr 11:851–854, 1987

    • Search Google Scholar
    • Export Citation
  • 27.

    Sandhu FS, & Dillon WP: Spinal epidural abscess: evaluation with contrast-enhanced MR imaging. AJNR 12:1087–1093, 1992 Sandhu FS, Dillon WP: Spinal epidural abscess: evaluation with contrast-enhanced MR imaging. AJNR 12:1087–1093, 1992

    • Search Google Scholar
    • Export Citation
  • 28.

    Tarlov IM: Acute spinal cord compression paralysis. J Neurosurg 36:10–20, 1972 Tarlov IM: Acute spinal cord compression paralysis. J Neurosurg 36:10–20, 1972

    • Search Google Scholar
    • Export Citation
  • 29.

    Tarlov IM: Spinal cord compression studies III. Time limits for recovery after gradual compression in dogs. Arch Neurol Psychiatry 71:588–597, 1954 Tarlov IM: Spinal cord compression studies III. Time limits for recovery after gradual compression in dogs. Arch Neurol Psychiatry 71:588–597, 1954

    • Search Google Scholar
    • Export Citation
  • 30.

    Tarlov IM, & Herz E: Spinal cord compression studies IV. Outlook with complete paralysis in man. Arch Neurol Psychiatry 72:43–59, 1954 Tarlov IM, Herz E: Spinal cord compression studies IV. Outlook with complete paralysis in man. Arch Neurol Psychiatry 72:43–59, 1954

    • Search Google Scholar
    • Export Citation
  • 31.

    Tarlov IM, & Klinger H: Spinal cord compression studies II. Time limits for recovery after acute compression in dogs. Arch Neurol Psychiatry 71:271–290, 1954 Tarlov IM, Klinger H: Spinal cord compression studies II. Time limits for recovery after acute compression in dogs. Arch Neurol Psychiatry 71:271–290, 1954

    • Search Google Scholar
    • Export Citation
  • 32.

    Tarlov IM, , Klinger H, & Vitale S: Spinal cord compression studies I. Experimental techniques to produce acute and gradual compression. Arch Neurol Psychiatry 70:813–819, 1953 Tarlov IM, Klinger H, Vitale S: Spinal cord compression studies I. Experimental techniques to produce acute and gradual compression. Arch Neurol Psychiatry 70:813–819, 1953

    • Search Google Scholar
    • Export Citation
  • 33.

    U HS, & Wilson CB: Postoperative epidural hematoma as a complication of anterior cervical discectomy. Report of three cases. J Neurosurg 49:288–291, 1978 U HS, Wilson CB: Postoperative epidural hematoma as a complication of anterior cervical discectomy. Report of three cases. J Neurosurg 49:288–291, 1978

    • Search Google Scholar
    • Export Citation
  • 34.

    Zillkha A, , Irwin GAL, & Fagelman D: Computed tomography of spinal epidural hematoma. AJNR 4:1073–1076, 1987 Zillkha A, Irwin GAL, Fagelman D: Computed tomography of spinal epidural hematoma. AJNR 4:1073–1076, 1987

    • Search Google Scholar
    • Export Citation
  • 35.

    Zuccarello M, , Scanarini M, & D'Avella D, et al: Spontaneous spinal extradural hematoma during anticoagulant therapy. Surg Neurol 14:411–413, 1980 Zuccarello M, Scanarini M, D'Avella D, et al: Spontaneous spinal extradural hematoma during anticoagulant therapy. Surg Neurol 14:411–413, 1980

    • Search Google Scholar
    • Export Citation

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