Spontaneous spinal epidural haematoma: a retrospective study of a series of 13 cases

Abstract

Introduction: Spontaneous spinal epidural haematoma (SSEH) has an estimated incidence of one per million inhabitants. It is classified as spontaneous when no identifiable cause can be linked to its onset.

Objective: To describe a sample of patients with SSEH and analyse variables related to its functional prognosis.

Patients and methods: Retrospective study carried out in patients diagnosed with SSEH between 2001 and 2013 in our hospital.

Results: We included 13 subjects (7 men) with a mean age of 71 years. Of the total, 62% had hypertension and 54% were treated with oral anticoagulants; of the latter, 57% had an International Normalised Ratio above 3. The most frequent manifestation was spinal column pain (85%). Nearly all subjects presented an associated neurological deficit, whether sensory-motor (70%), pure motor (15%), or pure sensory (7%). Five patients underwent surgical treatment and 8 had conservative treatment. After one year, 3 of the patients treated surgically and 4 of those on conservative treatment had a score of 2 or lower on the modified Rankin Scale. Poorer prognosis was observed in patients with anticoagulant therapy, large haematomas, location in the lumbar region, and more pronounced motor disability at onset.

Conclusions: Old age, hypertension, and anticoagulant therapy are the main risk factors for SSEH. The typical presentation consists of back pain with subsequent motor deficit. In patients with established motor symptoms, surgical treatment within the first 24hours seems to be the best option.

Keywords: Compresión medular; Enfermedades médula espinal; Epidural haematoma; Hematoma epidural; Hematoma espinal; Laminectomy; Laminectomía; Mielopatía; Myelopathy; Spinal cord compression; Spinal cord diseases; Spinal haematoma.