Chronic Spinal Epidural Hematoma Related to Kummell's Disease

Acute Paraparesis Caused by Spinal Epidural Fluid After Balloon Kyphoplasty for Traumatic Avascular Necrosis: A Case Report

Minimally invasive procedures, such as percutaneous vertebroplasty or balloon kyphoplasty (BK), eliminate motion at the fracture site and relieve pain associated with traumatic avascular necrosis when conservative treatment fails. However, these are associated with complications, most of which are directly related to cement leakage. Herein, we report a rare case of acute paraparesis caused by spinal cord compression by epidural fluid following BK for the treatment of Kummell's disease in the absence of cement leakage. To the best of our knowledge, this is the first report describing this complication.

Percutaneous vertebroplasty in osteoporotic vertebral compression fracture with huge spinal epidural hematoma: A case report

RATIONALE

Osteoporotic vertebral compression fracture (OVCF) accompanying huge spinal epidural hematoma (SEH) is fairly rare. The aim of this report is to investigate the management strategies and treatment outcomes of OVCF accompanying SEH.

PATIENT CONCERNS

An 89-year-old female patient was admitted to hospital because of severe back pain and numbness of both lower limbs after a slight fall. The magnetic resonance imaging examination of the patient showed a fresh compression fracture at L2 accompanying a large dorsal SEH which extended from the T12 to L3 and deformed the spinal cord.

DIAGNOSIS

The patient was diagnosed with OVCF accompanying SEH.

INTERVENTIONS

Given mild neurologic deficits, the hematoma was not treated, and the patient underwent percutaneous vertebroplasty (PVP) only.

OUTCOMES

After the procedure, immediate pain relief was achieved and the numbness of both lower limbs disappeared 3 days later. Three months after the procedure, the follow-up magnetic resonance imaging revealed a complete resolution of the hematoma.

LESSONS

OVCF accompanying SEH is fairly rare, and the exact pathophysiological mechanisms are still not clear. In selected patients without or with only slight neurologic symptoms, it is reasonable to perform PVP alone in OVCF accompanying SEH. Moreover, intravertebral stability after PVP might have played a role in spontaneous resolution of SEH.

Percutaneous vertebroplasty versus percutaneous kyphoplasty for the treatment of delayed post-traumatic vertebral body collapse (Kümmell’s disease) in Chinese patients: a systematic review and meta-analysis

Objective

To compare the clinical efficacy between percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of Kümmell’s disease in Chinese patients.

Methods

The studies using randomized controlled trials to compare clinical efficacy between PVP and PKP in the treatment of Kümmell’s disease in Chinese patients were retrieved from Embase, Pubmed, Central, Cinahl, PQDT, CNKI, CQVIP, Wanfang Data, and CBM (from September 2008 to September 2018). Keywords for both Chinese and English search were: percutaneous vertebroplasty, PVP, percutaneous kyphoplasty, PKP, and Kümmell’s disease. A total of 132 articles were retrieved based on the search strategy through online database searching and manual searching. Finally, one foreign report and seven Chinese reports were included. After extracting the data, statistical software Review Manager 5.3 was used for data analysis.

Results

Through comparison, Cobb angle (95% CI [0.54, 4.42), P = 0.01] and Oswestry Dysfunction Index (ODI) (95% CI [0.21, 2.15], P= 0.02) of PKP group was smaller than that of PVP group. Postoperative anterior vertebral body height of the PKP group was better than PVP group (95% CI [−1.27, −0.66], P < 0.001]. However, the PVP group had shorter operation time than PKP group (95% CI [−13.48, −7.43), P = 0.001]. In the other outcome measures, including Visual Analogue Scale (VAS) score (95% CI [−0.04, 0.27), P = 0.15), cement volume (95% CI [−0.82, 0.32], P = 0.39) and cement leakage (95% CI [0.90, 2.76], P = 0.11), there was no significant differences between the two procedures.

Conclusions

At this stage, there is sufficient evidence to support that PKP is better than PVP in the treatment of Kümmell’s disease in Chinese patients. Although PVP surgery requires much less operation time, PKP has better postoperative radiological results and lower ODI. Moreover, both of them had similar clinical results (e.g., analgesic effects, cement dosage, and leakage rate). Further evidence is dependent on the emergence of randomized controlled trials with higher quality and larger sample sizes in the future.

Radiologic Features and Clinical Course of Chronic Spinal Epidural Hematoma: Report of 4 Cases and Literature Review

BACKGROUND

Spinal epidural hematoma (SEH) is a potentially devastating problem that requires rapid diagnosis and surgical intervention. A chronic course is rarely seen following SEH, and the clinical characteristics are quite different from acute cases. The epidemiology, clinical history, and radiologic findings of chronic SEH (CSEH) are not well understood, although the detection rate has increased with the widespread use of magnetic resonance imaging. The purpose of this article was to report 4 cases of surgically confirmed CSEH and clarify the radiologic features and clinical scenarios by reviewing all published cases of CSEH.

CASE DESCRIPTION

All 4 patients presented with gradually worsening radicular pain in the lower extremities. Patients' mean age was 69.5 years (range, 55-85 years). Magnetic resonance imaging revealed an epidural mass in the lower lumbar spine that was heterogeneously enhanced after gadolinium administration. The rim of the mass was low intensity on T2*-weighted images. Local erosions of the adjacent cortical bone were seen with computed tomography in all cases. All patients' postoperative courses were satisfactory with complete disappearance of radicular symptoms.

CONCLUSIONS

CSEH is a rare disease, and it is difficult to diagnose preoperatively on the basis of diagnostic imaging. The incidence of a low-intensity rim on T2*-weighted images and bone erosions on computed tomography may help differentiate rare CSEH from other lumbar degenerative diseases and epidural space-occupying masses.