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Case Reports
. 2024 Sep 23;10(3):606-615.
doi: 10.21037/jss-24-49. Epub 2024 Aug 26.

Spontaneous spinal epidural hematoma in children: a case report and literature review

Marthinson Andrew Tombeng  1   2 , Kazuma Doi  2 , Tjokorda Gde Bagus Mahadewa  1 , Satoshi Tani  2 , Junichi Mizuno  2
Affiliations
Case Reports

Spontaneous spinal epidural hematoma in children: a case report and literature review

Marthinson Andrew Tombeng et al. J Spine Surg. .

Abstract

Background: Spontaneous spinal epidural hematoma (SSEH) is a hematoma within the spinal epidural space without the underlying causes of trauma or iatrogenic and is considered a very rare neurosurgical emergency disease in children that can cause spinal cord compression and neurological dysfunction. This article provides useful information and guidance to the clinician about SSEH in children regarding its specific characteristics, clinical presentation, and management strategy to achieve a better outcome.

Case description: A 14-year-old boy presented with an acute onset of neck pain radiating to the right shoulder and progressive right hemiparesis. The cervical spine magnetic resonance imaging (MRI) revealed a right posterolateral hyperacute spinal epidural hematoma at C4-C7. The patient underwent an emergent open-door laminoplasty (C5-C6) with partial laminectomy (C4 and C7) and complete evacuation of the hematoma. The patient had a complete recovery after surgery with no neurological deficits. A literature search in the PubMed electronic database was performed to identify published English articles between January 2000 to December 2023 focusing on SSEH in children. We have found 81 articles with a total of 95 cases of SSEH in children, providing comparison data on sex, age, clinical presentation, etiology, location of the hematoma, treatment modalities, and outcomes.

Conclusions: SSEH in children is a very rare neurosurgical emergency disease. Prompt and proper examination is essential to establish the diagnosis and early surgical decompression. Adequate surgical decompression may reduce intradural pressure and increase the blood perfusion to the spinal cord, thus, this will eventually reduce ischemia and prevent secondary spinal injury. As a result, complete recovery can be expected.

Keywords: Spontaneous spinal epidural hematoma (SSEH); case report; cervical laminoplasty; children.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jss.amegroups.com/article/view/10.21037/jss-24-49/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Cervical spine MRI showing SEH (white arrows) from C4 to C7 levels. (A) T1-weighted sagittal view; the SEH appeared isointense. (B) T2-weighted sagittal view; the SEH appeared hyperintense. (C) T2-weighted axial view at the level of C5/6 foramen; the SEH located at the right posterolateral compressing anteriorly the spinal cord to the left. MRI, magnetic resonance imaging; SEH, spinal epidural hematoma.
Figure 2
Figure 2
Open-door laminoplasty C5–C6. (A) SEH (white arrow) is exposed on the right side of the lamina. (B) Cervical laminoplasty using the laminoplasty plates. SEH, spinal epidural hematoma.
Figure 3
Figure 3
Post-operative CT scan. (A) Sagittal view; showed no residual hematoma in C4–C7. (B) Axial view of C6; laminoplasty using laminoplasty plates and well-decompressed spinal canal. CT, computed tomography.
See this image and copyright information in PMC

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