المؤلفون: Kissling, Cédric¹ (AUTHOR) cedric.kissling@insel.ch, Häni, Levin¹ (AUTHOR), Schär, Ralph T.¹ (AUTHOR), Goldberg, Johannes¹ (AUTHOR), Raabe, Andreas¹ (AUTHOR), Jesse, Christopher Marvin¹ (AUTHOR)

المصدر: Acta Neurochirurgica. 6/28/2024, Vol. 166 Issue 1, p1-9. 9p.

مصطلحات موضوعية: *SPINAL epidural hematoma, *TREATMENT effectiveness, *EPIDURAL space, *SPINAL canal, *FISHER exact test, *EPIDURAL abscess

مستخلص: Purpose: Spontaneous spinal epidural hematoma (SSEH) is a rare pathology characterized by a hemorrhage in the spinal epidural space without prior surgical or interventional procedure. Recent literature reported contradictory findings regarding the clinical, radiological and surgical factors determining the outcome, hence the objective of this retrospective analysis was to re-assess these outcome-determining factors. Methods: Patients surgically treated for SSEH at our institution from 2010 – 2022 were screened and retrospectively assessed regarding management including the time-to-treatment, the pre-and post-treatment clinical status, the radiological findings as well as other patient-specific parameters. The outcome was assessed using the modified McCormick Scale. Statistical analyses included binary logistic regression and Fisher's exact test. Results: In total, 26 patients (17 men [65%], 9 women [35%], median age 70 years [interquartile range 26.5]) were included for analysis. The SSEHs were located cervically in 31%, cervicothoracically in 42% and thoracically in 27%. Twenty-four patients (92%) improved after surgery. Fifteen patients (58%) had a postoperative modified McCormick Scale grade of I (no residual symptoms) and 8 patients (31%) had a grade of II (mild symptoms). Only 3 (12%) patients remained with a modified McCormick Scale grade of IV or V (severe motor deficits / paraplegic). Neither time-to-treatment, craniocaudal hematoma expansion, axial hematoma occupation of the spinal canal, anticoagulation or antiplatelet drugs, nor the preoperative clinical status were significantly associated with the patients' outcomes. Conclusion: Early surgical evacuation of SSEH generally leads to favorable clinical outcomes. Surgical hematoma evacuation should be indicated in all patients with symptomatic SSEH. [ABSTRACT FROM AUTHOR]

المؤلفون: Sharma, Shalini¹, Patir, Rana², Ahlawat, Sunita³, Gupta, Rakesh K.¹ rakeshree1@gmail.com

المصدر: Neurology Asia. 2024, Vol. 29 Issue 2, p471-475. 5p.

مصطلحات موضوعية: *SPINAL epidural hematoma, *HAMARTOMA, *HEMORRHAGE, *SYMPTOMS, *IDIOPATHIC diseases, *BACKACHE

مستخلص: Spinal epidural hematoma is a rare disease and is most commonly idiopathic. Other common causes are vascular malformations, coagulopathy, hypertension, surgery, and trauma. Epidural vascular hamartoma associated with hemorrhage is a less known entity. We report an unusual case of epidural vascular hamartoma associated with hemorrhage resulting in back pain and neurological deficits. A distinctive feature of this case was waxing and waning signs and symptoms with evidence of radiological resolution of the lesion in the phase of remission. [ABSTRACT FROM AUTHOR]

المؤلفون: Choucha, Anis^1,2 (AUTHOR) anis.c13@gmail.com, Beucler, Nathan³ (AUTHOR), Leroy, Henri-Arthur^4,5 (AUTHOR)

المصدر: Neurosurgical Review. 5/24/2024, Vol. 47 Issue 1, p1-5. 5p.

مصطلحات موضوعية: *SPINAL epidural hematoma, *SPINAL surgery, *SURGICAL decompression, *REOPERATION, *MINIMALLY invasive procedures, *SURGERY, *PROOF of concept

مستخلص: Background: Symptomatic spinal epidural hematoma (SSEH) is one of the most feared complications and source of litigation in spine surgery. Its occurrence rises up to 2% in minimally invasive spine surgery. In parts of the world where the population is aging, more fragile patients are expected to undergo degenerative spine surgery. Management of the SSEH includes emergent spine MRI, though some experts advocate for direct second-look surgery without imaging. Then, an urgent revision surgery under general anesthesia for hematoma evacuation is warranted. We report the case of a threatening SSEH in an 88-year-old patient after lumbar spine stenosis surgery. In order to spare a second general anesthesia for this fragile patient, we opted for a percutaneous ultra-sound guided drainage of the hematoma under local anesthesia as a first line treatment. The procedure was successful, we report an instant relief of his neurological deficit while performing the procedure. Conclusion: Ultra-sound guided percutaneous drainage of hyperacute SSEH successfully avoided a revision surgery. It spared a second general anesthesia in a fragile patient. This procedure could be an alternative first-line treatment of SSEH for fragile patients. [ABSTRACT FROM AUTHOR]

المؤلفون: Nerelius, Fredrik¹ fredrik.nerelius@oru.se, Sigmundsson, Freyr G.¹, Karlén, Niklas², Wretenberg, Per¹, Joelson, Anders¹

المصدر: Spine (03622436). 5/15/2024, Vol. 49 Issue 10, p701-707. 7p.

مصطلحات موضوعية: *SPINAL epidural hematoma, *PATIENT reported outcome measures, *SURGICAL decompression, *SPINAL stenosis, *SPINAL surgery, *VISUAL analog scale, *HEMATOMA

مستخلص: Study Design. Retrospective analysis of prospectively collected data from the National Swedish Spine Register (Swespine). Objective. The objective of this study was to evaluate the effects of symptomatic spinal epidural hematoma (SSEH) requiring reoperation on one-year patient-reported outcome measures (PROMs) in a large cohort of patients treated surgically for lumbar spinal stenosis. Summary of Background Data. Studies exploring the outcomes of reoperations after SSEH are scarce and often lack validated outcome measures. As SSEH is considered a serious complication, understanding of the outcome after hematoma evacuation is important. Materials and Methods. After retrieving data from 2007 to 2017 from Swespine, we included all patients with lumbar spinal stenosis without concomitant spondylolisthesis who were treated surgically with decompression without fusion. Patients with evacuated SSEH were identified in the registry. Back/leg pain numerical rating scales (NRSs), the Oswestry Disability Index (ODI), and EuroQol Visual Analogue Scale were used for the outcome assessment. PROMs before and one year after decompression surgery were compared between evacuated patients and all other patients. Multivariate linear regression was performed to determine whether hematoma evacuation predicted inferior one-year PROM scores. Results. A total of 113 patients with an evacuated SSEH were compared with 19527 patients with no evacuation. One-year after decompression surgery, both groups showed significant improvement in all PROMs. When comparing the two groups’ one-year improvement, there were no significant differences in any PROM. The proportion of patients achieving the minimum important change was not significantly different for any PROM. Multivariate linear regression found that hematoma evacuation significantly predicted inferior one-year ODI (β=4.35, P=0.043), but it was not a significant predictor of inferior NRS Back (β= 0.50, P= 0.105), NRS Leg (β=0.41, P=0.221), or EuroQol Visual Analogue Scale (β=−1.97, P= 0.470). Conclusions. A surgically evacuated SSEH does not affect the outcome in terms of back/leg pain or health-related quality of life. Commonly used PROM surveys may not capture neurological deficits associated with SSEH. [ABSTRACT FROM AUTHOR]

المؤلفون: Nakao, Satoshi¹ (AUTHOR), Hirata, Hirohito¹ (AUTHOR), Yoshihara, Tomohito¹ (AUTHOR), Kobayashi, Takaomi¹ (AUTHOR), Tsukamoto, Masatsugu¹ (AUTHOR), Egashira, Yoshiaki² (AUTHOR), Mawatari, Masaaki¹ (AUTHOR), Morimoto, Tadatsugu¹ (AUTHOR) sakiyuki0830@gmail.com

المصدر: Clinical Case Reports. May2024, Vol. 12 Issue 5, p1-5. 5p.

مصطلحات موضوعية: *SPINAL epidural hematoma, *PROGNOSIS, *MAGNETIC resonance imaging, *NECK pain, *COMPUTED tomography, *CONSERVATIVE treatment

مستخلص: Key Clinical Message: Sudden spinal epidural hematoma (SSEH) is relatively rare. Sudden pain from the neck to the back and subsequent extremity paralysis necessitate immediate head and cervical magnetic resonance imaging or computed tomography, keeping SSEH in mind. Although surgery is recommended for progressive paralysis, conservative treatment is indicated for mildly symptomatic cases. [ABSTRACT FROM AUTHOR]

المؤلفون: Chen, Jiasheng^1,2,3 (AUTHOR), Li, Haozheng^1,2,3 (AUTHOR), Zeng, Shengxin^1,2,3 (AUTHOR), Zhou, Hua^1,2,3 (AUTHOR), Liu, Xiao^1,2,3 (AUTHOR), Hu, Panpan^1,2,3 (AUTHOR), Liu, Xiaoguang^1,2,3 (AUTHOR), Liu, Zhongjun^1,2,3 (AUTHOR), Wei, Feng^1,2,3 (AUTHOR), Li, Zihe^1,2,3 (AUTHOR) skyhealth@qq.com

المصدر: European Spine Journal. May2024, Vol. 33 Issue 5, p2129-2137. 9p.

مصطلحات موضوعية: *SPINAL epidural hematoma, *EVOKED potentials (Electrophysiology), *SOMATOSENSORY evoked potentials, *PEARSON correlation (Statistics), *SPINAL cord injuries

مصطلحات جغرافية: ALABAMA

مستخلص: Purpose: The purpose of this study was to establish an animal model capable of simulating the development and decompression process of symptomatic spinal epidural hematoma (SSEH). Methods: A total of 16 male Bama miniature pigs were included in this study and randomly allocated into four groups: Group A (4 h 20 mmHg hematoma compression), Group B (4 h 24 mmHg hematoma compression), Group C (4 h 28 mmHg hematoma compression), and Group Sham (control). Real-time intra-wound hematoma compression values were obtained using the principle of connectors. Electrophysiological analyses, including the latency and amplitude of somatosensory evoked potentials (SSEP) and motor evoked potentials (MEP), along with behavioral observations (Tarlov score), were performed to assess this model. Results: ANOVA tests demonstrated significant differences in the latency and relative amplitude of SSEP and MEP between Groups C and Sham after 4 h of hematoma compression and one month after surgery (P < 0.01). Behavioral assessments 8 h after surgery indicated that animals subjected to 28 mmHg hematoma compression suffered the most severe spinal cord injury. Pearson correlation coefficient test suggested a negative correlation between the epidural pressure and Tarlov score (r = −0.700, p < 0.001). With the progression of compression and the escalation of epidural pressure, the latency of SSEP and MEP gradually increased, while the relative amplitude gradually decreased. Conclusions: When the epidural pressure reaches approximately 24 mmHg, the spinal cord function occurs progressive dysfunction. Monitoring epidural pressure would be an effective approach to assist to identify the occurrence of postoperative SSEH. [ABSTRACT FROM AUTHOR]

المؤلفون: Yabuki, Shunya¹ (AUTHOR), Hirai, Hiroyuki¹ (AUTHOR) hiroyuki@fmu.ac.jp, Miyajima, Masayuki² (AUTHOR), Moro, Takatomo³ (AUTHOR)

المصدر: Clinical Case Reports. Mar2024, Vol. 12 Issue 3, p1-4. 4p.

مصطلحات موضوعية: *SPINAL epidural hematoma, *OLDER patients, *ARTERIES, *SYMPTOMS, *BACKACHE, *ARTERIAL dissections

مستخلص: Key Clinical Message: An elderly patient with upper back pain and hypertension was diagnosed as having spontaneous spinal epidural hematoma (SSEH) after excluding artery dissection. The initial symptoms of SSEH mimic those of artery dissection, and the symptoms of spinal damage frequently appear later. Physicians should, therefore, be mindful of SSEH. [ABSTRACT FROM AUTHOR]

المؤلفون: Young Rok Ko¹, Dong Ki Ahn¹, Jung Soo Lee¹, Jong Seo Jung¹, Young Ho Lee¹, Yong Ho Kim¹ 1004zones@naver.com

المصدر: Asian Spine Journal. Feb2024, Vol. 18 Issue 1, p87-93. 7p.

مصطلحات موضوعية: *SPINAL epidural hematoma, *SPINAL surgery, *HEMOSTATICS, *SPINAL infusions, *ENDOSCOPIC surgery, *LOGISTIC regression analysis

مستخلص: Study Design: Retrospective case-control study. Purpose: This study aimed to investigate the preventive effect of thrombin-containing local hemostatics (TCLH) on postoperative spinal epidural hematoma (POSEH) in biportal endoscopic spinal surgery (BESS). This study compared the incidence of morphometric and symptomatic POSEH with or without TCLH in BESS. Overview of Literature: POSEH is reported not uncommon in BESS when compared with conventional spine surgery (CSS). TCLH achieves hemostasis with a high success rate in CSS. However, few studies have examined the effect of TCLH on BESS. Methods: Patients with and without TCLH were assigned to groups A and B, respectively. POSEH between the two groups was compared morphometrically and symptomatically. The risk factors for symptomatic and morphometric POSEH in BESS were identified. Results: The morphometric POSEH was greater in group B, and the difference was significant (p =0.019). The incidence of symptomatic POSEH was lower in group A with 4.6% (5/109) than in group B with 9.5% (9/95); however, the rate was not significantly different (p =0.136). The morphometric POSEH was classified into two small (hG1 and hG2) and large (hG3 and hG4) and were compared between groups A and B, and the difference was significant (p =0.02). In the multivariable logistic regression, nonuse of TCLH (p =0.004) and preoperative diagnosis of stenosis (p =0.016) were variables found to be significant risk factors of morphometric POSEH. Conclusions: Severe compression of the thecal sac by POSEH is more common in patients without TCLH. The risk of hematoma formation was higher when bilateral decompression was needed and the cut bone surface was more exposed. [ABSTRACT FROM AUTHOR]

المؤلفون: Morimoto, Tadatsugu¹ (AUTHOR) sakiyuki0830@gmail.com, Hirata, Hirohito¹ (AUTHOR), Nikaido, Takuya² (AUTHOR), Taniguchi, Kenichiro³ (AUTHOR), Yoshihara, Tomohito¹ (AUTHOR), Kobayashi, Takaomi¹ (AUTHOR), Tsukamoto, Masatsugu¹ (AUTHOR), Mawatari, Masaaki¹ (AUTHOR)

المصدر: Clinical Case Reports. Feb2024, Vol. 12 Issue 2, p1-5. 5p.

مصطلحات موضوعية: *SPINAL epidural hematoma, *PARAPLEGIA, *PARALYSIS, *EPIDURAL hematoma, *PSYCHIATRIC hospital care

مستخلص: Key Clinical Message: A woman with a history of psychiatric hospitalization was misdiagnosed with conversion paralysis despite lower extremity paralysis due to a thoracic epidural hematoma, leaving her with severe neurological deficits. Conversion paralysis is a diagnosis of exclusion and should never be made unless all possible organic causes have been ruled out. [ABSTRACT FROM AUTHOR]

المؤلفون: Yunhyung Choi¹, Yoon Hee Choi¹ unii@ewha.ac.kr

المصدر: Signa Vitae. Feb2024, Vol. 20 Issue 2, p102-104. 3p.

مصطلحات موضوعية: *SPINAL epidural hematoma, *PHYSICIANS, *BRADYCARDIA, *HYPOTHERMIA, *DYSARTHRIA, *NECK pain, *EPIDURAL abscess

مستخلص: Spinal epidural hemorrhage (EDH) after acupuncture is a rare disease and needs to be differentiated from stroke because it presents neurological deficits such as motor weakness. A 48-year-old patient taking anticoagulants developed posterior neck pain and progressive quadriplegia immediately after acupuncture. Upon arrival to the emergency room (ER), he complained of dyspnea, dysarthria, bradycardia, and hypothermia. Diffuse spinal EDH findings on spinal magnetic resonance imaging (MRI) were confirmed, and posterior decompression was performed emergently. The patient is currently recovering. Since dyspnea, dysarthria, bradycardia, and hypothermia complained of by this patient are not common symptoms of spinal cord injury, emergency medicine doctors should be careful not to miss the spinal cord injury through detailed history-taking and additional neurologic exam. [ABSTRACT FROM AUTHOR]