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  • Author or Editor: Cheng-Chih Liao x
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Cheng-Chih Liao, Po-Chuan Hsieh, Tzu-Kang Lin, Chih-Lung Lin, Yang-Lan Lo and Sai-Cheung Lee

Object

Spontaneous spinal epidural hematoma (SSEH) is a rare disease. The goal of this study was to clarify the treatment results and management options in SSEH.

Methods

Patients with SSEH who were surgically treated in the authors' center between June 2003 and June 2008 were included in this study. Patients were treated as early as possible if their neurological deficits were incomplete or had been complete for 12 hours or less. The patients were assigned to 1 of 2 groups based on completeness of preoperative cord dysfunction (complete vs incomplete deficit). Surgical outcomes of the 2 groups were compared by functional performance, coded as Nurick grades at 1, 3, and 6 months after the operation. Also compared were duration of hospital stay and the number of days needed to regain the ability to function independently (defined as Nurick Grades 1 and 2) after the operation.

Results

There were 17 patients (7 female and 10 male) with pathologically confirmed SSEH. Coagulopathy, greater size (length) of SSEH, and preoperative complete spinal dysfunction were found to contribute to poor postoperative functional recovery (p < 0.05). Patients with incomplete preoperative deficits (ASIA Impairment Scale Grades B, C, and D) were able to achieve functional independent recovery within a month after surgery and had significantly better outcomes (lower Nurick grades) at 1, 3, and 6 months postoperatively than those with complete deficits (p < 0.001, p = 0.027, and p = 0.027, respectively). Median time to independent functional recovery and median length of hospital stay were significantly shorter in patients with incomplete preoperative deficits than in those with complete deficits (6 vs 110 and 9 vs 58 days, respectively; both p < 0.001).

Conclusions

Impaired preoperative hemostasis contributes to larger size of SSEH, high probability of postoperative recurrence of spinal epidural hematoma, and poor functional recovery following surgical evacuation. Incomplete spinal cord dysfunction before surgery predicts good outcome and warrants emergent evacuation of SSEH especially in the cervical and thoracic regions, where the clots are located in proximity to the spinal cord.

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Cheng-Chih Liao, Shih-Tseng Lee, Wen-Chin Hsu, Li-Rong Chen, Tai-Ngar Lui and Sai-Cheung Lee

Object. Spontaneous spinal epidural hematoma (SSEH) is a rare disease entity. Although many cases have been reported in the literature, controversy persists as to its origin, diagnosis, and timing of treatment. The authors conducted a study in patients treated in their hospital and report the results.

Methods. Clinical data obtained in 35 patients with SSEH were retrospectively reviewed. Age, sex, history of hypertension, and history of anticoagulation therapy were recorded, and data were analyzed to clarify the possible predisposing factors of SSEH. Neurological outcomes were reappraised using a standardized grading system and correlated with the time interval from initial ictus to surgery, duration of complete neurological deficits, and the rapidity of deterioration of paralysis. Nonparametric methods and Spearman rank-correlation coefficients were used for statistical analysis.

Conclusions. Surgery is a safe and effective procedure to treat SSEH. The disease-related mortality rate was 5.7%, the surgery-related complication rate was 2.9%, and there were no operation-related deaths. Neurological outcome after surgery is positively correlated with preoperative neurological deficits (88.9% complete recovery in patients with incomplete neurological deficits compared with 37.5% in those with complete deficits [p < 0.001]). In patients in whom the time interval from initial ictus was shorter (< 48 hours) and in whom the duration of complete neurological symptoms was also briefer (< 12 hours), there is a positive correlation with better neurological and functional recovery (p < 0.05).