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Vastani A, Baig Mirza A, Khoja AK, Bartram J, Shaheen S, Rajkumar S, China M, Lavrador JP, Bleil C, Bell D, Thomas N, Malik I, Grahovac G. Prognostic factors and surgical outcomes of spontaneous spinal epidural haematoma: a systematic review and meta-analysis. Neurosurg Rev 2022; 46:21. [PMID: 36538111 DOI: 10.1007/s10143-022-01914-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2022] [Indexed: 12/24/2022]
Abstract
Spontaneous spinal epidural haematoma (SSEH) is a rare disease defined as blood accumulation within the vertebral epidural space without a cause identified, which can lead to severe neurological deficits. We aim to provide a comprehensive understanding of the prognostic factors affecting surgical outcomes in true SSEH and propose a critical time frame for operative management. A systematic literature search was performed and registered, using OVID Medline and EMBASE, in line with the PRISMA guidelines. Relevant demographic, clinical, surgical, and outcome data were extracted. The ASIA scale was uniformly used throughout our systematic review. Statistical analysis was performed via logistic regression. Of the 1179 articles examined, we included 181 studies involving 295 adult patients surgically treated for SSEH. SSEH were most commonly found in the cervicothoracic spine, with 2-4 spinal segments most commonly involved. Multivariable logistic regression model showed that the following factors were statistically significant in the post-operative outcome: operation type (P = 0.024), pre-operative neurologic status (P < 0.001), use of warfarin (P = 0.039), and operative interval (P = 0.006). Our retrospective analysis confirms the reversibility of severe neurological deficits after surgical intervention, with a prognosis of post-operative outcomes determined by the use of warfarin, pre-operative ASIA grade, and above all surgical evacuation within 12 h.
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Affiliation(s)
- Amisha Vastani
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK.
| | - Asfand Baig Mirza
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Abbas Khizar Khoja
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - James Bartram
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Safwan Shaheen
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Shivani Rajkumar
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Musa China
- Division of Medicine, University College London (UCL), London, UK
| | - Jose Pedro Lavrador
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Cristina Bleil
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - David Bell
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Nick Thomas
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Irfan Malik
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Gordan Grahovac
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
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Qiu W, Sun W, Guo C, Wu Z, Ding M, Shen H. Diagnosis and microsurgery of symptomatic spontaneous spinal epidural hematoma. Ir J Med Sci 2010; 180:241-5. [PMID: 20680702 DOI: 10.1007/s11845-010-0533-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Accepted: 07/08/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND Symptomatic spontaneous spinal epidural hematoma (SSEH) is an uncommon cause of cord compression that needs emergent treatment. Without effective management of the symptomatic SSEH, irreversible severe spinal injury would be possible. OBJECTIVES We aimed to investigate the diagnosis and surgical management of symptomatic SSEH. METHODS Five cases of symptomatic SSEH with favorable neurological recovery after emergent microsurgery were prospectively analysed. RESULTS The main clinical presentations were root pain and palsy. The main manifestations of MRI were long-segment epidural lesions of high intensity on T1- and T2-weighted images without enhancement. Laminectomy via posterior approach and hematoma removal were undergone for all patients. All patients achieved full neurological recovery without complications. CONCLUSIONS MRI manifestation assisted with the main clinical symptoms may aid the preoperative diagnosis of SSEH, and the delay in obtaining preoperative Digital subtraction angiography is worthwhile, especially for those with progressive neurological deterioration.
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Affiliation(s)
- W Qiu
- Department of Neurosurgery, Hangzhou Second Hospital, College of Medicine, Hangzhou Normal University, Hangzhou, 310015, China
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Deger SM, Emmez H, Bahadirli K, Kale A, Ebinc FA, Turkoglu M, Arinsoy T, Sindel S. A spontaneous spinal epidural hematoma in a hemodialysis patient: a rare entity. Intern Med 2009; 48:2115-8. [PMID: 20009403 DOI: 10.2169/internalmedicine.48.2335] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Hemodialysis patients are at an increased risk of bleeding due to the platelet dysfunction caused by uremia and the use of anticoagulants during dialysis. Spontaneous spinal hematoma is a rare disorder as a complication in hemodialysis patients. Also it includes the hematoma secondary to coagulopathy, vascular malformation and hemorrhagic tumors. Here, we report the case of 77-year-old woman who presented with spinal cord compression due to spontaneous spinal epidural hematoma associated with hemodialysis. When an end-stage renal disease patient suffers from back pain and neurological deficits, the clinician should be alerted for the spontaneous spinal epidural hematoma as well as cerebrovascular events.
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Affiliation(s)
- Serpil Muge Deger
- Department of Nephrology, Gazi University Faculty of Medicine, Ankara, Turkey.
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Bayir A, Akilli B, Cengiz S. Spinal Epidural Haematoma Related to Oral Anticoagulant Overdose. Neuroradiol J 2008; 21:368-70. [DOI: 10.1177/197140090802100311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2008] [Accepted: 02/27/2008] [Indexed: 11/17/2022] Open
Abstract
The most important complication during the treatment of oral anticoagulants is bleeding and it is seen most commonly in the skin, urinary system, gastrointestinal tract and central nervous system. Spinal epidural bleeding related to oral coagulant overdose is a rare complication and it may require urgent surgical treatment depending on the neurological clinical chart. This paper describes a patient with spinal epidural haematoma defined by imaging methods due to paraparesis which developed during oral coagulant usage and its treatment.
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Affiliation(s)
- A. Bayir
- Selçuk University, Meram Faculty of Medicine; Meram, Konya, Turkey
| | - B. Akilli
- Selçuk University, Meram Faculty of Medicine; Meram, Konya, Turkey
| | - S.L. Cengiz
- Selçuk University, Meram Faculty of Medicine; Meram, Konya, Turkey
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Zhang H, He M, Mao B. Thoracic spine extradural arteriovenous fistula. ACTA ACUST UNITED AC 2006; 66 Suppl 1:S18-23; discussion S23-4. [PMID: 16904990 DOI: 10.1016/j.surneu.2006.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2006] [Accepted: 05/19/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Spinal extradural arteriovenous fistula is a rare, disabling, but potentially treatable disease. Only 27 cases have been reported so far in the past 40 years. CASE DESCRIPTION An 18-year-old adolescent girl developed repeated back pain and mild paraplegia after a training course. Magnetic resonance imaging revealed a vessel-like lesion at the spinal extradural space, compressing the spinal medulla at the T5 level. Angiography disclosed a focal fistula fed by branches of the intercostal artery. The vascular mass was surgically removed and confirmed pathologically. CONCLUSION Spinal extradural arteriovenous fistulas have an arterial supply that originates outside the spinal dura, with venous draining into the spinal extradural venous plexus. They may lead to myelopathy, radiculopathy, or spontaneous extradural hematoma, due to dilated vein compression, blood stealing, or spinal venous hypertension. Extradural hematoma needs emergency laminectomy and clot evacuation. And extradural arteriovenous fistulas should be treated actively by embolization, surgical resection, or both. Appropriate treatment will stabilize the patient or result in neurological improvement.
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Affiliation(s)
- Heng Zhang
- Department of Neurosurgery, West China Hospital, West China Clinical Medical School, Sichuan University, Chengdu, Sichuan Province 610041, PR China.
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