Risk Factors and Postoperative Prognostic Factors of Spontaneous Spinal Epidural Hematoma

Whoan Jeang Kim; Sang Wook Jeung; Gyu Sang Lee; Kyung Hoon Park; Kun Young Park; Won Cho Kwon; Hwan Il Seong; Won Sik Choy

doi:10.4184/jkss.2015.22.4.165

Journal List > J Korean Soc Spine Surg > v.22(4) > 1076065

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Kim, Jeung, Lee, Park, Park, Kwon, Seong, and Choy: Risk Factors and Postoperative Prognostic Factors of Spontaneous Spinal Epidural Hematoma

Original Article

Journal of Korean Spine Surg 2015;22(4):165-169.

Published online: 21 December 2015

DOI: https://doi.org/10.4184/jkss.2015.22.4.165

Risk Factors and Postoperative Prognostic Factors of Spontaneous Spinal Epidural Hematoma

Whoan Jeang Kim, M.D., Sang Wook Jeung, M.D., Gyu Sang Lee, M.D., Kyung Hoon Park, M.D., Kun Young Park, M.D., Won Cho Kwon, M.D., Hwan Il Seong, M.D., Won Sik Choy, M.D.

Department of Orthopedic Surgery, Eulji University School of Medicine, Daejeon, Korea

Corresponding author: Sang Wook Jeung, M.D. Department of Orthopaedic Surgery, Eulji University College of Medicine, 1306, Dunsan-dong, Seo-gu, Daejeon 302-799, Korea TEL: +82-42-611-3279, FAX: +82-42-611-3283 E-mail: realpuck@gmail.com

Received 31 July 201512 August 2015 Accepted 3 December 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

Retrospective study.

Objectives

To explore the risk factors and the factors associated with the neurological improvement after operation in the spontaneous spinal epidural hematoma.

Summary of Literature Review

The cause of the spontaneous spinal epidural hematoma is unknown. The objective risk and prognostic factors are still controversial.

Materials and Methods

From January 2006 to December 2014, a total of 12 patients with spontaneous epidural hematoma were evaluated. The risk and prognostic factors analyzed were sex, age, underlying diseases, medications, neurologic status, level and extent of hematoma, cord edema, and interval from onset to surgery. We analyzed the correlation between each factor and neurologic recovery. The neurologic status was analyzed using the American Spinal Injury Association impairment scale (AIS) at the first and the last neurologic examination.

Results

The average age of the patients was 68.6 years. Seven patients were treated with anticoagulation therapy, and two were advised to switch to a healthier diet. The initial neurologic status of the patients was AIS A in 2 cases, B in 5 cases, C in 4 cases, D in 1 case, and in two patients, cord edema was revealed on magnetic resonance imaging (MRI). The interval of time from onset to surgery was less than 24 hours in 6 cases, 24–48 hours in 4 cases, and more than 48 hours in 2 cases.

Conclusions

The prognostic factors associated with spontaneous spinal epidural hematoma were found to be initial neurologic status, cord edema on MRI, and interval from onset to surgery. We found no correlation between anticoagulation therapy or healthy diet and spontaneous spinal epidural hematoma, but anticoagulation therapy cannot be excluded as a risk factor.

Keywords: Spontaneous spinal epidural hematoma, Risk factor, Prognostic factor, Healthy

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Fig. 1.

Sagittal MRI obtained from a 67-year-old woman suffering from sudden onset back pain and neurologic deficiency (AIS Grade D). There was no history of underlying disease or any medication. (A) A sagittal T1-weighted image shows a fusiform longitudinal epidural mass extending from T10 to L2, compressing the spinal cord, isointense with the spinal cord. (B) A sagittal T2-weighted image reveals hyperintensity.

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