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Journal ArticleDOI

Myelopathy caused by chronic epidural hematoma associated with l1 osteoporotic vertebral collapse: a case report and review of the literature.

Itaru Oda1, Masanori Fujiya, Kyoichi Hasegawa, Satoshi Terae 
26 Mar 2008-The Open Orthopaedics Journal (Bentham Science Publishers)-Vol. 2, Iss: 1, pp 40-42

TL;DR: A case of myelopathy caused by chronic epidural hematoma associated with L1 osteoporotic vertebral collapse is reported and the relevant literature is reviewed.

AbstractEpidural hematoma associated with osteoporotic vertebral collapse has not been reported yet in the literature. We report a case of myelopathy caused by chronic epidural hematoma associated with L1 osteoporotic vertebral collapse and review the relevant literature.

Topics: Epidural hematoma (58%), Myelopathy (56%)

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Journal ArticleDOI
TL;DR: Although the optimal treatment has not been determined for patients of OVC with DND in this study, the analysis could provide guidance for choosing an appropriate approach and it is believed that individualized surgical approach should be introduced based on the clinical characteristics of each patient.
Abstract: Intrtoduction Osteoporotic vertebral collapse (OVC) with delayed neurological deficits (DND) is one severe subtype of OVC, for which surgical intervention is more complicated and difficult. Although many individual case reports and series have described the surgery for stabilization and neurological decompression of OVC with DND, no systematic review has been published. Methods We searched eligible studies in PubMed , SCOPUS , EMBASE and ISIWeb of Knowledge for eligible studies and conducted comprehensive analysis. Results A total of 29 publications involving 596 patients of OVC with DND were included in this review. There are 36.6%, 60.6% and 2.8% of patients receiving anterior neural decompression and reconstruction, posterior surgery which can be further divided into 6 distinct groups, and posteroanterior surgery, respectively. Among them, patients in the posteroanterior surgery had the longest time (351.0 min) for operation and the largest volume of mean blood loss (2892.0 ml). For clinical outcomes, patients in the posterior spinal shortening osteotomy with direct neural decompression group had the most significantly LKA correction effect, with mean LKA correction 21.3°, while the posterior decompression and posterior column reconstruction group exhibited the lowest LKA correction loss rate (14.7%). Conclusion Although the optimal treatment has not been determined for patients of OVC with DND in this study, our analysis could provide guidance for choosing an appropriate approach. Besides, effective treatment for OVC with DND requires multidisciplinary collaboration, such as geriatricians, interventional radiologists, respiratory disease experts, and spine surgeons. On light of the above analysis, we believe that individualized surgical approach should be introduced based on the clinical characteristics of each patient.

12 citations


Cites background from "Myelopathy caused by chronic epidur..."

  • ...Previous studies revealed that the following several factors could confer risk to OVC with DND: 1) neural compression secondary to retropulsed bone fragments; 2) progression of kyphosis with vertebral collapse; 3) intravertebral instability at fracture sites; and 4) OVC-triggered foraminal stenosis and nerve injury-caused chronic epidural hematoma [8,17,20]....

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Journal ArticleDOI
TL;DR: A 79-year-old woman developed neurological deficits 6 weeks after the onset of a thoracic osteoporotic compression fracture and acute decompressive laminectomy and percutaneous vertebroplasty were performed, and follow-up MR imaging showed complete resolution of the hematoma.
Abstract: A 79-year-old woman developed neurological deficits 6 weeks after the onset of a thoracic osteoporotic compression fracture. Magnetic resonance (MR) imaging of the thoracic spine revealed an epidural hematoma at the T10-L2 levels. Acute decompressive laminectomy and percutaneous vertebroplasty were performed. Following the surgery, the patient's neurologic deficits improved and follow-up MR imaging showed complete resolution of the hematoma. Spinal epidural hematomas are rare and associated delayed neurological deficits are extremely rare. Conservative treatment may be effective for epidural hematomas in neurologically intact patients, but epidural hematomas can be a cause of neural compression and symptomatic deterioration resulting in delayed neurological deficits during the follow-up period.

6 citations


Journal ArticleDOI
TL;DR: An 82-year-old woman who had been managed conservatively for seven weeks with the diagnosis of a multi-level osteoporotic compression fracture, and a percutaneous vertebroplasty was performed, showed a nearly complete resolution of the hematoma.
Abstract: Chronic spinal epidural hematoma related to Kummell's disease is extremely rare. An 82-year-old woman who had been managed conservatively for seven weeks with the diagnosis of a multi-level osteoporotic compression fracture was transferred to our institute. Lumbar spine magnetic resonance images revealed vertebral body collapse with the formation of a cavitary lesion at L1, and a chronic spinal epidural hematoma extending from L1 to L3. Because of intractable back pain, a percutaneous vertebroplasty was performed. The pain improved dramatically and follow-up magnetic resonance imaging obtained three days after the procedure showed a nearly complete resolution of the hematoma. Here, we present the rare case of a chronic spinal epidural hematoma associated with Kummell's disease and discuss the possible mechanism.

3 citations


Journal ArticleDOI
TL;DR: Although rare, the possibility of refracture of Kummell disease and spinal epidural hematoma should be kept in mind in patients with osteoporotic fractures.
Abstract: Background Kummell disease is defined as avascular necrosis of vertebra, occurs after the delayed posttraumatic osteoporotic vertebral collapse, and mainly occurs in adults older than 50 years of age. We report the first case of refracture of Kummell disease and epidural hematoma followed by paraparesis. Case Description A 67-year-old woman with a known case of osteoporotic T12 fracture (3 months back) visited our outpatient clinic complaining of persistent back pain and paraparesis after jerking while getting up from the bed. Her neurology worsened suddenly in the next 2 days. A physical examination revealed grade 3 power in lower extremities with a lower extremity paresthesia and diminished bilateral knee and ankle reflexes. Urinary retention was also present. A plain radiographic examination of her thoracolumbar spine revealed osteoporotic compression fractures with almost 50% reduction in height of the 12th thoracic vertebra. Magnetic resonance imaging showed dorsal epidural soft tissue mass that caused posterior compression of the spinal cord at the T12-L3 levels. We performed thoracic lateral retropleural corpectomy and cage insertion at T12. Bone cement−augmented pedicle screw fixation was performed at the T10, T11, and L1 levels with laminectomy and decompression of hematoma at the T12, L1, L2, and L3 levels as a stage 1 procedure. Conclusions Although rare, the possibility of refracture of Kummell disease and spinal epidural hematoma should be kept in mind in patients with osteoporotic fractures. Periodic follow-up and treatment are essential for preventing tragic neurologic impairment.

1 citations


References
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Journal ArticleDOI
TL;DR: This large series of SEH demonstrates that rapid diagnosis and emergency surgical treatment maximize neurological recovery, however, patients with complete neurological lesions or long-standing compression can improve substantially with surgery.
Abstract: Thirty patients were treated surgically for spinal epidural hematoma (SEH). Twelve of these cases resulted from spinal surgery, seven from epidural catheters, four from vascular lesions, three from anticoagulation medications, two from trauma, and two from spontaneous causes. Pain was the predominant initial symptom, and all patients developed neurological deficits. Eight patients had complete motor and sensory loss (Frankel Grade A); six had complete motor loss but some sensation preserved (Frankel Grade B); and 16 had incomplete loss of motor function (10 patients Frankel Grade C and six patients Frankel Grade D). The average interval from onset of initial symptom to maximum neurological deficit was 13 hours, and the average interval from onset of symptom to surgery was 23 hours. Surgical evacuation of the hematoma was performed in all patients; 26 of these improved; four remained unchanged, and no patients worsened (mean follow up 11 months). Complete recovery (Frankel Grade E) was observed in 43% of the patients and functional recovery (Frankel Grades D or E) was observed in 87%. One postoperative death occurred from a pulmonary embolus (surgical mortality 3%). Preoperative neurological status correlated with outcome; 83% of Frankel Grade D patients recovered completely compared to 25% of Frankel Grade A patients. The rapidity of surgical intervention also correlated with outcome; greater neurological recovery occurred as the interval from symptom onset to surgery decreased. Patients taken to surgery within 12 hours had better neurological outcomes than patients with identical preoperative Frankel grades whose surgery was delayed beyond 12 hours. This large series of SEH demonstrates that rapid diagnosis and emergency surgical treatment maximize neurological recovery. However, patients with complete neurological lesions or long-standing compression can improve substantially with surgery.

524 citations


"Myelopathy caused by chronic epidur..." refers background in this paper

  • ...Spinal epidural hematoma is mostly spontaneous, postsurgical, or post-traumatic including spinal fracture [1-6]....

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  • ...Spinal epidural hematoma may result from coagulopathy, vascular lesions, iatrogenesis, spontaneous occurrence, and fresh spinal injuries [1-8]....

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Journal ArticleDOI
TL;DR: The critical factors for recovery after spontaneous spinal epidural hematoma are the level of preoperative neurological deficit and the operative interval, which suggests that local compression, rather than vascular obstruction, is the main factor in producing neurological deficit.
Abstract: OBJECTIVE: We clarify the factors affecting postoperative outcomes in patients who have suffered spontaneous spinal epidural hematomas. METHODS: We review 330 cases of spontaneous spinal epidural hematomas from the international literature and three unpublished cases of our own. Attention was focused on sex, age, medical history, mortality, size and position of the hematoma, vertebral level of the hematoma, preoperative neurological condition, operative interval, and postoperative result. RESULTS: Sex, age, and size and position of the hematoma did not correlate with postoperative outcome. Mortality correlated highly with cervical or cervicothoracic hematomas, especially in patients with cardiovascular disease and those undergoing anticoagulant therapy. Incomplete preoperative sensorimotor deficit correlated highly with favorable outcomes (P < 0.0005), and recovery was significantly better when decompression was performed in < or = 36 hours in patients with complete sensorimotor loss (P < 0.05) and in < or = 48 hours in patients with incomplete sensorimotor deficit (P < 0.005). CONCLUSION: The critical factors for recovery after spontaneous spinal epidural hematoma are the level of preoperative neurological deficit and the operative interval. The vertebral level of the hematoma did not correlate with postoperative results, which suggests that local compression, rather than vascular obstruction, is the main factor in producing neurological deficit.

315 citations


Journal ArticleDOI
TL;DR: The postoperative progress of 3 patients with spinal epidural hemorrhage, but without spinal fracture or dislocation, is presented and the absence of motor or sensorimotor functions preoperatively does not necessarily indicate a poor prognosis.
Abstract: The postoperative progress of 3 patients with spinal epidural hemorrhage, but without spinal fracture or dislocation, is presented. From the literature, 158 cases were collected of spontaneous spinal epidural hematoma treated surgically. Postoperative return of motor function was noted in 95.3%, 87%, and 45.3% of the patients with incomplete sensorimotor, incomplete sensory but complete motor, and complete sensorimotor lesions, respectively. Complete sensorimotor recovery occurred in 41.9%, 26.1%, and 11.3% of these 3 groups of patients, respectively. Recovery following surgical treatment depends on the severity of neurological deficits before treatment. However, the absence of motor or sensorimotor functions preoperatively does not necessarily indicate a poor prognosis.

269 citations


"Myelopathy caused by chronic epidur..." refers background in this paper

  • ...Spinal epidural hematoma is mostly spontaneous, postsurgical, or post-traumatic including spinal fracture [1-6]....

    [...]

  • ...Spinal epidural hematoma may result from coagulopathy, vascular lesions, iatrogenesis, spontaneous occurrence, and fresh spinal injuries [1-8]....

    [...]


Journal ArticleDOI

207 citations


"Myelopathy caused by chronic epidur..." refers background in this paper

  • ...Spinal epidural hematoma may result from coagulopathy, vascular lesions, iatrogenesis, spontaneous occurrence, and fresh spinal injuries [1-8]....

    [...]


Journal ArticleDOI
01 Aug 1992-Spine
TL;DR: Twenty-two patients with neurologic deficit due to delayed posttraumatic vertebral collapse after osteoporotic compression fractures of the thoracolumbar spine underwent anterior decompression and reconstruction with bioactive Apatite-Wollastonite containing glass ceramic vertebral prosthesis and Kaneda instrumentation.
Abstract: Twenty-two patients with neurologic deficit due to delayed posttraumatic vertebral collapse after osteoporotic compression fractures of the thoracolumbar spine underwent anterior decompression and reconstruction with bioactive Apatite-Wollastonite containing glass ceramic vertebral prosthesis and Kaneda instrumentation. Eighteen patients previously had minor trauma that resulted in a mild vertebral compression fracture without any neurologic involvement and were either conservatively treated or not treated at all. Four had no history of back injury. The preoperative neurologic status was incomplete paralysis in all patients. The average age at surgery was 66 (53-79) years. The average follow-up was 34 (20-58) months after surgery. All patients had returned to their daily living with neurologic recovery and stable spine. This type of anterior procedure is effective in the osteoporotic patients and there was a very low incidence of instrumentation failure and very low morbidity.

195 citations


"Myelopathy caused by chronic epidur..." refers background in this paper

  • ...It is inferred that osteoporotic vertebral collapse rarely causes epidural hematoma because osteoporotic vertebral collapse is not an acute phase of fractures [9-11]....

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  • ...It is widely recognized that osteoporotic vertebral collapse sometimes causes neurological impairment [9-11]....

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  • ...Osteoporotic vertebral collapse is a kind of pseudarthrosis and gradually results from a vertebral fracture in the osteoporotic spine [9-11]....

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