Operative treatment of spontaneous spinal epidural hematomas: a study of the factors determining postoperative outcome.
About: This article is published in Neurosurgery.The article was published on 1997-11-01 and is currently open access. It has received 218 citations till now. The article focuses on the topics: Spinal cord compression & Hematoma.
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TL;DR: The ASRA consensus statements represent the collective experience of recognized experts in the field of neuraxial anesthesia and anticoagulation and are based on case reports, clinical series, pharmacology, hematology, and risk factors for surgical bleeding.
1,319 citations
TL;DR: Neuraxial anesthesia and analgesia provide several advantages over systemic opioids, including superior analgesia, reduced blood loss and need for transfusion, decreased incidence of graft occlusion, and improved joint mobility following major knee surgery.
926 citations
TL;DR: In this paper, the authors identify factors that favour spontaneous recovery in patients who suffered a spontaneous spinal epidural hematoma (SSEH) in non-operative cases of SSEH.
Abstract: Objective To identify factors that favour spontaneous recovery in patients who suffered a spontaneous spinal epidural hematoma (SSEH) Methods The literature was reviewed reguarding non-operative cases of SSEH (SSEHcons) Sixty-two cases from the literature and 2 of our own cases were collected, focusing on sex, age, medical history, position of the hematoma, segmental distribution and length of the hematoma, diagnostic imaging, neurological condition and outcome Those data were analysed and compared with the data from a literature review of 474 cases operated on because of a SSEH (SSEHoper) Results The mean length of the hematoma was significantly higher in SSEHcons, compared to SSEHoper (54 versus 42 vertebral segments; [standard error of the difference (SED) is 038 vertebral segments; 95% confidence limits for the difference are 045 to 195]) Also after exclusion of patients with coagulopathy, mean length of the hematoma was significantly higher in SSEHcons (47 versus 39 vertebral segments [SED is 039 vertebral segment; 95% confidence limits for the difference are 004 to 156]) Neurological signs and symptoms in SSEHcons were significantly less severe (P<0005) and diagnosis was based on Magnetic Resonance Imaging (MRI) in the majority of cases (P<00005), when compared to SSEHoper All other patient characteristics showed no correlation with spontaneous recovery Conclusion The recent increase of publications of SSEHcons has to be explained by the introduction of MRI in daily medical practice As a result, more patients with a mild or benign clinical course are being diagnosed In earlier times those patients would have escaped medical attention The mean length of the hematoma in SSEHcons appears to be significantly higher compared to SSEHoper This suggests that spontaneous regression of neurological symptoms may result from decompression of the neural structures by spreading of the (liquid) hematoma along the spinal epidural space in the early stages after haemorrhage Based on the present review, there appear to be no factors which promote conservative treatment in SSEH In the majority of cases with SSEH, the mainstay of treatment will remain surgical decompression of the neural structures and removal of the hematoma The decision for conservative treatment has to be based on the severity of the neurological deficit and on the clinical course Retrospectively, the length of the hematoma seems to give a clue to the spontaneous recovery which occurs in some cases of SSEH Nevertheless, hematoma-length can not be used as a guide to treatment
229 citations
TL;DR: Surgery is a safe and effective procedure to treat Spontaneous spinal epidural hematoma and Neurological outcome after surgery is positively correlated with preoperative neurological deficits.
Abstract: Object. Spontaneous spinal epidural hematoma (SSEH) is a rare disease entity. Although many cases have been reported in the literature, controversy persists as to its origin, diagnosis, and timing of treatment. The authors conducted a study in patients treated in their hospital and report the results. Methods. Clinical data obtained in 35 patients with SSEH were retrospectively reviewed. Age, sex, history of hypertension, and history of anticoagulation therapy were recorded, and data were analyzed to clarify the possible predisposing factors of SSEH. Neurological outcomes were reappraised using a standardized grading system and correlated with the time interval from initial ictus to surgery, duration of complete neurological deficits, and the rapidity of deterioration of paralysis. Nonparametric methods and Spearman rank-correlation coefficients were used for statistical analysis. Conclusions. Surgery is a safe and effective procedure to treat SSEH. The disease-related mortality rate was 5.7%, the surgery...
145 citations
TL;DR: The favorable factors for SSEH operations were incomplete neurological injury at the time of the preoperative status and the short operative time interval, and the neurological outcome improved after the surgical operation.
Abstract: Spontaneous spinal epidural hematoma (SSEH) is a rare disease entity; its causative factors and the factors determining the outcome are still controversial. We reviewed our clinical experiences and analyzed the various factors related to the outcome for SSEH. We investigated 14 patients (11 men and 3 women) who underwent hematoma removal for SSEH from April 1998 to August 2004. We reviewed age, gender, hypertension, anticoagulant use and the preoperative neurological status using the Japanese Orthopaedics Association score by examining medical records, operative records, pathology reports, and radiographies, retrospectively. We were checking for factors such as the degree of cord compression owing to hematoma and the extent and location of the hematoma. Most patients included in the study were in their twenties or fifties. Four hematoma were located in the cervical region (29%), three were cervicothoracic (21%), four were thoracic (29%) and three were in the lumbar (21%) region and also 12 were located at the dorsal aspect of the spinal cord. In all cases, the neurological outcome improved after the surgical operation. There was a statistically significant difference between the incomplete and complete neurological injury for the preoperative status (P<0.05). The neurological outcome was good in those cases that had their hematoma removed within 24 h (P<0.05). The patients with incomplete neurological injury who had a surgical operation performed within 12 h had an excellent surgical outcome (P<0.01). Spontaneous spinal epidural hematoma was favorably treated by the means of a surgical operation. The favorable factors for SSEH operations were incomplete neurological injury at the time of the preoperative status and the short operative time interval.
133 citations
Cites background or methods from "Operative treatment of spontaneous ..."
...evacuate the hematoma and perform spinal cord decompression by an emergency operation [13, 32]....
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...Groen and Van Alphen [13] asserted that recovery was better when decompression was performed within 36 h for patients with complete sensorimotor loss and within 48 h for patients with an incomplete sensorimotor deficit....
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...Most authors also have asserted that the neurological outcome was strongly related with the time interval, that is, from symptom onset to surgical decompression [2, 6, 13, 24, 28, 32, 34]....
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...But other authors reported that there was no interrelation between the hematoma’s extent and the neurological outcome [13, 28]....
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...Some authors [4, 17, 27, 35, 38] have reported that the conservative treatment is effective, but the standard management is a quick diagnosis and evacuation of hematoma by a surgical operation [2, 6, 13, 18, 21, 24, 28, 32, 34]....
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References
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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.
329 citations
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.
286 citations
TL;DR: Complete motor tetraplegia with incomplete sensory loss was caused by spontaneous epidural bleeding from an arteriovenous malformation in the cervical region.
Abstract: Complete motor tetraplegia with incomplete sensory loss was caused by spontaneous epidural bleeding from an arteriovenous malformation in the cervical region. There was a family and personal history of cutaneous hemangioma.
45 citations