Prognostic Factors for Surgically Managed Spontaneous Spinal Epidural Hematoma: A Single-Center Case Series of 18 Patients

Author:

Baig Mirza Asfand1ORCID,Pedro Lavrador Jose1,Gebreyohanes Axumawi2,Vastani Amisha1,China Musa23,Kalaitzoglou Dimitrios1,Bartram James1,Eid Hazem1ORCID,Bleil Christina1,Bell David1,Thomas Nicholas1,Malik Irfan1,Grahovac Gordan1

Affiliation:

1. Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom;

2. Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, UK;

3. University College London (UCL) Medical School, London, UK

Abstract

BACKGROUND: Spontaneous spinal epidural hematoma (SSEH) is a rare pathology, which carries a significant morbidity. OBJECTIVE: To review our institutional experience of surgically managed patients with SSEH, seeking to better understand clinical prognostic factors related to postoperative outcomes and thereby improve counseling of patients before treatment. METHODS: All patients who underwent surgical management of SSEH between September 2011 and 2021. Baseline and postoperative clinical and radiological characteristics are presented, including the American Spinal Injury Association grade (ASIA). Statistical analyses were performed using Stata 13.1. RESULTS: Eighteen patients were identified in total (11 male patients and 7 female patients) with a median age of 59.5 (range 3-83) years. The most common spinal region affected was cervicothoracic (33.3%). Limb weakness (94.4%) and urinary dysfunction (83.3%) represented the most common presenting symptoms. Preoperatively, the presence of spinal cord edema on imaging was associated with worse preoperative Medical Research Council (MRC) grade (P = .033), female sex was associated with preserved saddle sensation (P = .04), and patients receiving antiplatelet medication were associated with a higher risk of preoperative axial back pain (P = .005). Higher postoperative MRC grade was associated with higher preoperative ASIA (P = .012) and MRC grade (P = .005), and preservation of saddle sensation (P = .018). Postoperative improvements in axial back pain were associated with higher preoperative ASIA grade (P = .035) and anticoagulation treatment (P = .029). CONCLUSION: Neurosurgical intervention for SSEH yields positive outcomes and benefits patients. Patients with higher preoperative ASIA, MRC grade, and those presenting with preserved saddle sensation may experience further improved clinical outcomes after intervention.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Neurology (clinical),Surgery

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