gms | German Medical Science

Spontaneous epidural hematoma of rachis is a clinical entity which the definition is discussed. The term “spontaneous” can mean either the absence of a combination with a spinal trauma or the absence of detectable cause. We report six cases with the analysis of the cause.

Our six cases were collected over a six-year period. Two women and four men, with an age from 55 to 77 year-old. The diagnosis was confirmed with CT scan and MRI (5 patients), myélo-scan (1 patient). The surgical treatment occurred during the first six hours in five patients : laminectomy 4, anterior 1, one patient received a medical treatment with a MRI monitoring and spontaneous recovery.

The term “spontaneous” spinal epidural hematoma should be discussed regarding the predisposing factor like anticoagulant treatment (5 cases), including a patient with a cervical hematoma after lumbar herniated intervertebral disc resection under spinal anesthesia, rheumatoid spondylitis (1 case). The term “atraumatic” should replace the term “spontaneous”, because of predisposing factors. The beginning is always a strong pain (4 cases) with radicular irradiation (upper limbs (3 cases), lower limbs (3 cases)). In one case, a patient described a stiff neck. A deficit motor and sensitive was present in all patients: hemiparesis (1 case), quadriparesis (2 cases), paraparesis (1 case). Two patients had flaccid paraplegia with the absence of recovery in one case and a death in the other case. The injuries were at the cervical (4 cases) and dorsal levels (2 cases). The hematoma were located along one, two or three segments in respectively one, three, or two patients. Four hematoma were posterior and two anterior related to the spinal cord. The surgery was performed urgently in five cases with a decompressive laminectomy. One patient was not operated with a rapid evolution under clinical and radiological monitoring (MRI). After surgery, four patients were improved with two full recovery and two neurological sequelae. One patient kept the initial neurological deficit persisting, and one patient died from complications of decubitus position.

The entity spontaneous epidural spine hematoma is currently well-described, but its pathophysiological aspects remain wooly. The predisposing factors are usualy found, especially the anticoagulant treatment. The designation “atraumatic” seems more suitable to this injury than the term “spontaneous”. An emergent surgery is required in most of cases.