Etiopathogenesis of Traumatic Spinal Epidural Hematoma

Abstract

Spinal epidural hematoma (SEH) is a rare cause of nerve root or cord compression; its pathogenesis is not always clearly recognizable. The aim of this paper was to investigate possible etiopathological factors in a consecutive series of patients affected by traumatic SEH treated at our institution. Seven patients with neurologic impairment due to traumatic SEH were retrospectively analyzed after diagnosis and surgical treatment. Thoracic localization was found in 5 cases, and lumbar and cervical localization were found in 1 patient each. One patient was affected by ankylosing spondylitis and one by diffuse idiopathic skeletal hyperostosis. SEH was associated with spine fractures in 6 cases. Only 2 cases of traumatic SEH resulted from high-energy trauma. All patients underwent surgical decompression within 24 hours after admittance to the hospital. Three patients recovered completely, 3 remained paraplegic, and 1 remained monoplegic. Several concomitant conditions are suggested to be predisposing factors for the development of SEH, although its inherent mechanism is still unknown. Two patients in the present series were affected by rheumatologic disorders, confirming the elevated incidence of hematomas in such patients compared to the normal population. Three very unusual cases of SEH occurred in senile patients affected by osteoporotic fractures. Early diagnosis and urgent decompression of the hematoma remain mandatory.

Keywords: Osteoporotic fractures; Spinal cord compression; Spinal epidural hematoma.

Fig. 1.

Sagittal computed tomography (A) and T2-weighted magnetic resonance imaging (B) of the lumbar spine in a 59-year-old male patient affected by ankylosing spondylitis, showing the displaced fracture of L5 after a high energy fall, associated to a hematoma in the posterior part of the epidural space.

Fig. 2.

Fracture of T3 in a 78 years old male patient affected by diffuse idiopathic skeletal hyperostosis and an epidural hematoma extended from the C6–7 intervertebral disc to T9 vertebral body. The hematoma shows its maximum size and the greatest compressive effect on the spinal cord at the level of the fracture of T3 vertebral body.

Fig. 3.

Fracture of T11 from accidental fall in a 79-year-old woman during chemotherapy for non-Hodgkin lymphoma. Sagittal T1 (A) and T2 (B) weighted and axial magnetic resonance imaging (C) images show an expanding mass in the epidural space with the typical signal intensities due to the catabolism of meta-hemoglobin.

Fig. 4.

Macroscopic, intraoperative images of a spinal epidural hematoma before and after its removal.