Risk Factors and Postoperative Prognostic Factors of Spontaneous Spinal Epidural Hematoma

ABSTRACT

STUDY DESIGN: Retrospective study. OBJECTIVES: To explore the risk factors and the factors associated with the neurological improvement after operation in the spontaneous spinal epidural hematoma. SUMMARY OF LITERATURE REVIEW: The cause of the spontaneous spinal epidural hematoma is unknown. The objective risk and prognostic factors are still controversial. MATERIALS AND METHODS: From January 2006 to December 2014, a total of 12 patients with spontaneous epidural hematoma were evaluated. The risk and prognostic factors analyzed were sex, age, underlying diseases, medications, neurologic status, level and extent of hematoma, cord edema, and interval from onset to surgery. We analyzed the correlation between each factor and neurologic recovery. The neurologic status was analyzed using the American Spinal Injury Association impairment scale (AIS) at the first and the last neurologic examination. RESULTS: The average age of the patients was 68.6 years. Seven patients were treated with anticoagulation therapy, and two were advised to switch to a healthier diet. The initial neurologic status of the patients was AIS A in 2 cases, B in 5 cases, C in 4 cases, D in 1 case, and in two patients, cord edema was revealed on magnetic resonance imaging (MRI). The interval of time from onset to surgery was less than 24 hours in 6 cases, 24-48 hours in 4 cases, and more than 48 hours in 2 cases. CONCLUSIONS: The prognostic factors associated with spontaneous spinal epidural hematoma were found to be initial neurologic status, cord edema on MRI, and interval from onset to surgery. We found no correlation between anticoagulation therapy or healthy diet and spontaneous spinal epidural hematoma, but anticoagulation therapy cannot be excluded as a risk factor.