Spinal epidural haematoma: MRI-aided diagnosis

Post-traumatic thoracolumbar spinal epidural haematoma in a child: a rare clinical entity

Post-traumatic spinal epidural haematoma (SEH) is a rare clinical entity in children. We are reporting the case of an 8-year-old child who presented with thoracolumbar SEH with neurological deficit. MRI confirmed SEH without bony disruption. Emergency evacuation of haematoma was done. There was an improvement in neurological status after removal of haematoma. Diagnosis of this rare condition is tricky in children owing to variable presenting symptoms, especially in an early stage with subtle neurological changes. There should be high clinical suspicion in children with atypical symptoms, and MRI should be done to confirm the diagnosis. Patients with acute neurological deficit should undergo urgent operative decompression. Conservative treatment has a limited role. Patients may be considered for non-operative management if they have medical contraindications, coagulation dysfunction or a small SEH without neurological deficit. These patients require serial MRI monitoring.

A New Grading of Epidural Hematoma or Scar Formation after Posterior Cervical Spine Surgery: Evaluation of Perioperative Related Factors, Distributions, and Clinical Outcomes after Surgery

Introduction

The purpose of this study was to evaluate surgical outcomes using a new grading of postoperative epidural hematoma (EH) or epidural scar formation after posterior cervical spine surgery.

Methods

Postoperative EH or epidural scar formation after cervical laminoplasty (LP) or posterior decompression and fusion (PDF) were graded into Grades 1-5 by magnetic resonance imaging at 24 hours, 2 weeks, 6 months, and one year after surgery. The patients were divided into the Mild group (Grades 1-3) and the Severe group (Grades 4, 5). Perioperative factors were compared between the two groups at 24 hours after surgery. Distribution of EH or scar formation was investigated according to two surgeries. The recovery rate of Japanese Orthopedic Association (JOA) scores and the improvements of neck disability index (NDI) were compared between the two groups at one year postoperatively.

Results

Of the postoperative factors, posterior shift of the cervical spinal cord at C4 and C7 significantly differed between the two groups. Patients in the Severe group at 24 hours after surgery (17%) increased to 41% at 2 weeks and subsequently decreased to 16% at 6 months after LP. After PDF, 3% in the Severe group at 24 hours after surgery increased to 15% at 2 weeks and then decreased to 3% at 6 months postoperatively. Only one (3%) patient remained in the Severe group at 1 year after PDF. The recovery rate of JOA score (47.5%) of the patients in the Mild group showed trend larger than that of the Severe group (34.7%) after LP. Preoperative NDI (15.6 points) significantly improved postoperatively to 12.1 points in only the Mild group after LP.

Conclusions

The patterns of distribution of EH or scar formation did not differ between the two surgical methods. The severity of postoperative scar formation related to surgical outcomes after LP.

Clinical experience and management of cervico-thoracic epidural hematoma

Spinal epidural hematoma (SEH) causing acute myelopathy is rare. The usual clinical presentation of a SEH is sudden severe neck or back pain that progresses toward paraparesis or quadriparesis, depending on the level of the lesion. Recent studies have shown that early decompressive surgery is very important for patient's recovery. We experienced five patients of cervico-thoracic epidural hematomas associated with neurologic deficits that were treated successfully with surgical intervention.

Spinal epidural hematoma in a scoliotic patient with long fusion: a case report

BACKGROUND CONTEXT

This is the only reported case on a spinal epidural hematoma occurring in a fused scoliotic segment.

PURPOSE

To report the first case of a spinal epidural hematoma developed within the fused segment of a scoliotic curve and to raise clinicians' awareness of the pathology of a spinal epidural hematoma.

STUDY DESIGN/SETTING

A case report.

PATIENT SAMPLE

A 53-year-old woman with long spinal fusion for severe kyphoscoliosis diagnosed as a teenager.

OUTCOME MEASURES

Neurological improvement and clinical follow-up for any occult spinal fracture.

METHODS

A patient was surgically treated for a spinal epidural hematoma causing paraparesis. Clinical and radiological features were reported.

RESULTS

The etiology of this case could not be defined, although the patient had a minor fall injury. Radiography and computed tomography scans could not detect any obvious fracture. Magnetic resonance imaging showed typical features of an epidural hematoma. After the hematoma evacuation, the patient's neurology gradually improved.

CONCLUSIONS

Long fusion, differential stiffness along the fusion block, implant removal, and significant residual deformity may increase the risk of an epidural hematoma formation after trivial trauma without an obvious fracture on imaging. Clinicians should be mindful of this possibility and look out for any hematoma in the fused segment(s).

Apport de l’imagerie par résonance magnétique dans les traumatismes médullaires

PURPOSE

To describe MR features of spinal trauma and assess the value of MR imaging in the prognosis.

MATERIAL AND METHODS

Retrospective confrontation between initial and follow up MRI findings and clinical features in 7 young patients with spinal cord injury.

RESULTS

Five lesions were due to motor vehicle accidents and 2 lesions were secondary to falls. Five patients had multiple associated injuries, 1 patient had associated spinal vertebrae injury, the last had Spinal Cord injury Without Radiological Abnormalities (SCIWRA). A motor deficit was noted in 5 cases of paraplegia, a case of monoplegia and a case of tetraparesia. The initial MRI showed in 3 cases intramedullary hemorrhage, cord edema in 2 cases and spinal cord compression and contusion in 1 case. Initial MRI was not done in the remaining case. No cord transection was noted. Outcomes were marked by lack of significant neurological recovery with complications due to bed confinement in 5 cases, and complete neurolgical recovery in two cases. In follow up, MR findings included post traumatic cystic lesion (2 cases), "ad integrum" restitution (1 case), segmental atrophy with gliosis (2 cases) and myelomalacia in the 2 other cases.

CONCLUSION

MR may offer new possibilities in establishing the prognosis for neurological recovery. Our study demonstrated a good correlation between imaging findings, clinical features and outcomes. A hemorrhagic contusion in the acute stage indicated a poor prognosis while a focal hyperintense area on T2-weighted images may resolve.