Retrospective Analysis of 14 Cases of Spinal Epidural Hematoma

Byung-Sub Kim; Sang-Bok Lee; Jong-Hyun Kim; Tae-Gyu Lee; Do-Sung Yoo; Pil-Woo Huh; Kyoung-Suok Cho

doi:10.13004/jknts.2011.7.2.51

Clinical Article

J Korean Neurotraumatol Soc 2011;7(2):51-56.

Published online: 31 October 2011

DOI: https://doi.org/10.13004/jknts.2011.7.2.51

Retrospective Analysis of 14 Cases of Spinal Epidural Hematoma

Byung-Sub Kim, Sang-Bok Lee, Jong-Hyun Kim, Tae-Gyu Lee, Do-Sung Yoo, Pil-Woo Huh, Kyoung-Suok Cho

Department of Neurosurgery, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Uijeongbu, Korea

Address for correspondence: Sang-Bok Lee, MD Department of Neurosurgery, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea College of Medicine, 65-1 Geumo-dong, Uijeongbu 480-130, Korea Tel: +82-31-820-3299, Fax: +82-31-846-3117 E-mail: doctorwish@hanmail.net

Received 8 February 2010 Revised 14 February 2011 Accepted 7 April 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

Spinal epidural hematoma (SEH) is rare diseases and they may have various causes. We reviewed our clinical experiences and analyzed the various factors related to the outcome for SEH.

Methods

We investigated 14 patients (8 men and 6 women) who underwent hematoma removal for SEH from January 2003 to December 2010. We investigated age, gender, hypertension, anticoagulant use, radiographic finding such as the degree of cord compression and the extent and location of the hematoma and relationship between preoperative neurologic status, surgical timing and neurological outcome using the Japanese Orthopaedic Association (JOA) score by examining medical records.

Results

In ten cases (71.4%) of operated 14 cases, there were post-operative improvements (recovery scale >50%) in clinical symptoms. We performed operation within 12 hour for seven cases, and the average of recovery scale for these cases was 69.9%. Six (85.7%) of these cases improved more than 50% on the recovery scale. There were seven cases that we performed operations on that were beyond 12 hour, and the average of the recovery scale was 47.7%. The average of the recovery scale in cases of incomplete injury after the operation was 64.4%, and the average of the recovery scale was 38.1% in cases of complete injury. There was a significant difference between two groups (p<0.05).

Conclusion

Our present study demonstrates that surgical time interval and preoperative neurological status correlated with neurological recovery. The rapidity of surgical intervention and preoperative favorable neurological status maximize neurological recovery.

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Keywords: Traumatic subdural hygroma, Chronic subdural hematoma, Head injuries, Old ages

FIGURE 1.

Preoperative and Postoperative MRI of 61 year-old male patient (case 7). He visited to emergency room with lower extremities weakness and voiding difficulty after ESWL treatment for urolithiasis. Sagittal T2- (A) and axial T2-weighted (B) magnetic resonance images of an acute epidural hematoma with maximal compression at the T10-12 level (arrows). T10-L1 total laminectomy was performed. Postoperative sagittal T2-weighted (C) magnetic resonance images show no cord compression. ESWL: extracorporeal shock wave lithotripsy.

FIGURE 2.

The relationship between surgical timing and neurological outcome. Outcome correlates inversely with the time interval from symptom onset to surgery (Spearman rank correlation coefficient=-0.68, p<0.05).

FIGURE 3.

The relationship between pre-operative neurological status and post-operative outcome. The postoperative surgical results are correlated with pre-operative neurological status. (Spearman rank correlation coefficient=0.8, p<0.05). JOA: Japanese Orthopaedic Association.

Table 1.

The characteristic of SSEH in 14 patients

	Sex	Age	Neurology	Lesion	Etiology	Initial JOA	Pre-op JOA	Interval (hour)	Compression degree %	Recovery scale (%)
1	M	18	SM incompl	C2-3	Trauma	15	17	11	37.6	100
2	F	21	SM incompl	C3-5	Trauma	13	15	8	42.1	50
3	M	18	SM incompl	C2-D4	Angiolipoma	12	14	26	56.4	40
4	M	69	SM compl	C3-D4	Anticoagulant	0	4	8	78.6	36.3
5	F	52	SM incompl	T1-6	Angiolipoma	5	8	16	58.6	50
6	F	67	SM compl	T9-12	Idiopathic	0	3	15	62.5	27.2
7	M	61	SM incompl	T10-12	ESWL	6	10	13	38	80
8	F	73	SM compl	T11-12	Idiopathic	0	7	9	64.1	63.6
9	M	43	SM incompl	T11-12	Trauma	7	9	15	58.8	50
10	M	52	SM compl	L1-5	Idiopathic	0	6	4	57.3	55.5
11	F	54	SM incompl	L1-5	Anticoagulant	7	10	8	76.9	75
12	M	23	SM incompl	L4-5	Trauma	7	9	36	72.1	50
13	F	27	SM incompl	L1-4	Postop. Cx	5	11	8	59	100
14	M	30	SM incompl	L4-S1	Trauma	6	9	15	68.1	60

ESWL: extracorporeal shock wave lithotripsy, S: sensory, M: motor, comp: complete, incompl: incomplete, Postop. Cx: postoperative complication, JOA: Japanese Orthopaedic Association

Table 2.

Improvement in recovery scale (n=14; values are mean±SD)

Neurological status	JOA score initial	JOA score after operation	Recovery scale
Incomplete (10)	7.9±2.3	13.2±1.8	64.4%^*
Complete (4)	0	5.2±2.8	38.10%

^* p<0.05 (significant difference between the complete and incomplete neurological injury after operation).

JOA: Japanese Orthopaedic Association

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