Surgical treatment of spontaneous spinal epidural hematoma. A four-year experience

Background: Spontaneous spinal epidural hematoma (SSEH) is a rare disease. The treatment results and management options remain unclear and need to be clarified. Object: From Jan. 2003 to Mar. 2007, 15 cases of SSEH were surgically treated as early as possible if the patient's neurological deficits were incomplete or within 12 hours of completeness. The results of treatment were reported. Materials and methods: The patients were grouped by completeness of pre-operative spinal cord dysfunction. Surgical outcomes of two groups were compared by functional performance, coded as Nurick grades at one, three and six months after the operation. Also compared were the admission duration of patients, and the days patients needed to regain independent functionality of life (defined as Nurick grades I and 2) after the operation. Result: Patients with incomplete preoperative deficits could recover to independent functional activity within one month, but no one with complete deficits did (p=0.002). Comparatively, the patients with incomplete preoperative deficits needed shorter median days (5.0 days) for independent functional recovery and shorter median days (8.5 days) of admission than the patients with complete deficits (median days = 60 and 49 days, with p = 0.002 and 0.002, respectively). Conclusions: Early evacuation of SSEH is recommended when the clinical motosensory deficits remain incomplete. provoked by irritation of SSEH, but never regained independent functionality of life after a three year follow up, and furthermore, one of them died of sepsis from a pressure sore 4 months after the operation. The duration of deficit completeness was not correlated with the treatment results in the study (p=0.2).