Spontaneous Spinal Epidural Hematoma: A Surgical Case Series of Ten Patients

Background: Spontaneous spinal epidural hematoma (SS-EDH) is a rare neurosurgical emergency. Little is known about predictive factors of outcome in patients with SS-EDH. Here, we present a case series of patients operated on for an SS-EDH.

Methods: We reviewed all cases of patients operated on for an SS-EDH between January 2009 and February 2016 in a large academic neurosurgical center. We recorded preadmission functional status, bleeding characteristics, and postsurgery outcome. Good outcome was defined, according to the Nurick score, as at least being able to walk in a way that did not prevent employment. Mean follow-up time was 19 months (standard deviation, 25 months).

Results: Ten patients, with a mean age of 70 years (standard deviation, 10), with SS-EDH were included. The location of SS-EDH was binomially distributed, with the highest frequencies in the upper thoracic region (Th3-5) and middle to low cervical region (C4-6). Five patients had a poor outcome. Of these, 3 remained chair bound or bedridden. No statistically significant association could be found between preoperative characteristics and outcome, but patients with poor preoperative motor function, thoracic hematoma, and more than 4 involved segments had a high rate of poor neurologic outcome. We could not establish any association between time delay from symptom onset to surgery and outcome.

Conclusions: In our series, half of the patients with SS-EDH recovered well after surgery. Although no statistically significant association could be established, hematoma location, size, and preoperative motor function seem to be some of the most important predictive factors of postoperative recovery.