Clinical characteristics and early treatment of acute spontaneous spinal epidural hematoma

English Keywords:Acute spontaneous spinal epidural hematoma  Spinal cord compression  Microsurgery  Outcomes

English Abstract:

  【Abstract】 Objectives: To summarize the clinical and radiological features of acute spontaneous spinal epidural hematoma(ASSEH), and to explore different treatments and their outcomes and prognoses. Methods: The clinical and radiological data of 27 patients with ASSEH treated in our department from January 2005 to December 2020 were collected, and the etiology, clinical feature, imaging manifestation, therapeutic strategy, therapeutic process, operation timing and method were analyzed. The visual analogue scale(VAS), American Spinal Injury Association(ASIA) grade, and Japanese Orthopaedic Association(JOA) score before and after operation and at the final follow-up were compared to assess the improvement of neurological function and prognosis. Results: Of all the patients, there were 15 males and 12 females, aged 31.3±15.9 years(15 to 81 years). The imaging data revealed that the hematoma sizes extended across 2-5 vertebral levels(averaged 2.3±0.9), including 15 cases in cervical segment, 10 in thoracic segment, and 2 in lumbar segment. And in 24 cases, the initial symptoms were pain, followed by spinal cord dysfunction, while in the other 3 cases, the patients had sudden onset of limb numbness or paralysis. On admission, the VAS score of all the patients was 6.7±1.9; 16 cases were of ASIA grade A, 6 of grade B, 4 of grade C, and 1 of grade D; and JOA score for cervicothoracic patients was 4.1±4.4(0-15). 5 cases(1 ASIA grade A, 3 grade C, and 1 grade D) received conservative treatments, and the other 22 cases underwent microsurgery within 4h to 7d, including posterior laminectomy, removal of hematoma under microscope, and resection of suspected abnormal vessels and lamina reduction. On discharge, among the 5 cases with conservative treatments, 1 of ASIA grade A recovered to grade B; 2 of the 3 grade C cases recovered to D, and the other 1 remained grade C; 1 of grade D recovered to E; VAS score decreased from 4.6±1.1 to 1.4±1.1; JOA score improved from 11.3±2.5 to 13.6±3.1, with an improvement rate(IR) of 40.3%. Of the 22 cases undergone surgery, 4 of the 15 ASIA grade A patients remained grade A, 6 recovered to B and 5 recovered to C; and 1 case of the 6 grade B patients remained grade B, 3 recovered to C, and the other 2 recovered to D; VAS score dropped from preoperative 7.2±1.7 to 1.0±1.2, JOA score improved from 2.8±3.2 to 7.3±3.9, with an IR of 31.7%. All the patients were followed up for 6-54 months(averaged 21.8±10.5 months). Of the 5 cases with conservative treatments, VAS was 0.20±0.44, and JOA was 15.0±2.0, with an IR of 64.9％; 1 of grade A recovered to D, 1 of the 3 grade C recovered to D, and the other 2 recovered to E. Of the 22 cases undergone surgery, VAS score was 0.3±0.6, and JOA score was 12.1±5.3, with an IR of 67.7%; 2 of the 15 grade A patients remained grade A, 1 recovered to B, 1 to C, 3 to D, 8 to E; 1 of the 6 grade B patients recovered to grade C, 5 to E; 1 grade C patient recovered to grade E. Conclusions: The initial symptoms of ASSEH patients are sudden pain in neck, shoulder, chest and back as well as spinal nerve dysfunction, and early diagnosis and therapy are crucial. For patients with severe symptoms of spinal cord compression and with obvious progression, early microsurgery intervention provides promising outcomes.