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Lu J, Zhang W, Jiang G, Luo K, Cai K, Zhang K, Lu B. Risk factors for spinal subdural hematoma after minimally invasive transforaminal lumbar Interbody Fusion (MI-TLIF): a multivariate analysis. BMC Musculoskelet Disord 2023; 24:939. [PMID: 38053117 DOI: 10.1186/s12891-023-06902-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/21/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Spinal subdural hematoma (SSH) is a rare cause of compression of the neutral elements of the spinal cord. However, little is known about the presentation of acute SSH after lumbar spine surgery. The reason for this may be that symptomatic SSH occurs rarely and is not given enough attention by spine surgeons. Currently, the decision to perform MRI postoperatively is more dependent on surgeon preference; therefore, no high-quality studies have been published. Our team reports our experience in the diagnosis and management of SSH after lumbar decompression and fusion surgery. METHODS We retrospectively studied 215 patients who underwent routine MRI following minimal invasive transforaminal lumbar interbody fusion (MI-TLIF) between 2020-01-01 and 2022-06-30. The patients were divided into SSH group (17 cases) and non-SSH group (198 cases) according to the occurrence of SSH. Univariate analysis and multivariate logistic regression analysis were performed to identify relevant risk factors that increase the risk of SSH postoperatively. RESULTS None of the patients presented with serious neurologic symptoms, such as lower extremity paralysis or cauda equina syndrome that required emergency hematoma debridement. SSH was found in 17 (7.9%) patients and non-SSH in 198 (92.1%). Factors affecting SSH were presence of hypertension, presence of diabetes and postoperative anticoagulant therapy. The significantly independent risk factor of postoperative SSH were diabetes (P = 0.008, OR: 6.988) and postoperative anticoagulant therapy (P = 0.003, OR: 8.808). CONCLUSIONS SSH after MI-TLIF is not a rare condition, with generally no requirement of emergency evacuation. Comprehensive anti-symptomatic treatment could achieve satisfactory results. Diabetes mellitus and postoperative anticoagulant therapy are independent risk factors for SSH. Spine surgeons should hold applicability of the use of anticoagulants after lumbar surgery.
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Affiliation(s)
- Jiye Lu
- Department of Spinal Surgery, The First Affiliated Hospital of Ningbo University, Work, 315000, China
| | - Wei Zhang
- Department of Spinal Surgery, The First Affiliated Hospital of Ningbo University, Work, 315000, China
| | - Guoqiang Jiang
- Department of Spinal Surgery, The First Affiliated Hospital of Ningbo University, Work, 315000, China
| | - Kefeng Luo
- Department of Spinal Surgery, The First Affiliated Hospital of Ningbo University, Work, 315000, China
| | - Kaiwen Cai
- Department of Spinal Surgery, The First Affiliated Hospital of Ningbo University, Work, 315000, China
| | - Kai Zhang
- Department of Spinal Surgery, The First Affiliated Hospital of Ningbo University, Work, 315000, China
| | - Bin Lu
- Department of Spinal Surgery, The First Affiliated Hospital of Ningbo University, Work, 315000, China.
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Wang H, Yu H, Zhang N, Xiang L. Incidence, Risk Factors, and Management of Postoperative Hematoma Following Anterior Cervical Decompression and Fusion for Degenerative Cervical Diseases. Neurospine 2023; 20:525-535. [PMID: 37401070 PMCID: PMC10323355 DOI: 10.14245/ns.2245066.533] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 07/05/2023] Open
Abstract
OBJECTIVE Studies discussed few risk factors for specific patients, such as duration of disease; or surgical factors, such as duration and time of surgery; or C3 or C7 involvement, which could have led to the formation of hematomas (HTs). To investigate the incidence, risk factors especially the factors mentioned above, and management of postoperative HTs following anterior cervical decompression and fusion (ACF) for degenerative cervical diseases. METHODS Medical records of 1,150 patients who underwent ACF for degenerative cervical diseases at our hospital between 2013 and 2019 were identified and reviewed. Patients were categorized into the HT group (HT group) or normal group (no-HT group). Demographic, surgical and radiographic data were recorded prospectively to identify risk factors for HT. RESULTS Postoperative HT was identified in 11 patients, with an incidence rate of 1.0% (11 of 1,150). HT occurred within 24 hours postoperatively in 5 patients (45.5%), while it occurred at an average of 4 days postoperatively in 6 patients (54.5%). Eight patients (72.7%) underwent HT evacuation; all patients were successfully treated and discharged. Smoking history (odds ratio [OR], 5.193; 95% confidence interval [CI], 1.058-25.493; p = 0.042), preoperative thrombin time (TT) value (OR, 1.643; 95% CI, 1.104-2.446; p = 0.014) and antiplatelet therapy (OR, 15.070; 95% CI, 2.663-85.274; p = 0.002) were independent risk factors for HT. Patients with postoperative HT had longer days of first-degree/intensive nursing (p < 0.001) and greater hospitalization costs (p = 0.038). CONCLUSION Smoking history, preoperative TT value and antiplatelet therapy were independent risk factors for postoperative HT following ACF. High-risk patients should be closely monitored through the perioperative period. Postoperative HT in ACF was associated with longer days of first-degree/intensive nursing and more hospitalization costs.
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Affiliation(s)
- Hongwei Wang
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, China
| | - Hailong Yu
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, China
| | - Ning Zhang
- Department of Orthopedics, The Second Hospital of Chaoyang, Chaoyang, China
| | - Liangbi Xiang
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, China
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Ahrari I, Jamali M, Mohammadi S, Ghavipisheh M, Eghbal K, Saffarian A, Rahmanian A, Ghahramani S, Taheri R. Spontaneous idiopathic spinal subdural hemorrhage in a 16-year-old boy: A rare case in pediatrics and review of literature. Clin Case Rep 2023; 11:e6993. [PMID: 36852126 PMCID: PMC9957699 DOI: 10.1002/ccr3.6993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 01/21/2023] [Accepted: 02/07/2023] [Indexed: 02/27/2023] Open
Abstract
Idiopathic spinal subdural hematoma (SSDH) is a rare phenomenon. Here, we present a 16-year-old-boy who presented with acute sudden onset weakness and brown squared syndrome; the cervical MRI findings showed acute subdural hematoma from C2 to C6. Emergent surgical intervention was performed, and significant improvement was seen in follow-ups.
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Affiliation(s)
- Iman Ahrari
- Department of NeurosurgeryShiraz University of Medial SciencesShirazIran
| | - Mohamad Jamali
- Department of NeurosurgeryShiraz University of Medial SciencesShirazIran
| | - Somayeh Mohammadi
- Department of Anesthesiology, Preoperative and Pain Medicine, Brigham and Woman's HospitalHarvard Medical SchoolBostonMAUSA
| | - Mahsa Ghavipisheh
- Department of PsychiatryShiraz University of Medial SciencesShirazIran
| | - Keyvan Eghbal
- Department of NeurosurgeryShiraz University of Medial SciencesShirazIran
| | - Arash Saffarian
- Department of NeurosurgeryShiraz University of Medial SciencesShirazIran
| | | | - Soulmaz Ghahramani
- Health Policy Research Center, Institute of HealthShiraz University of Medical SciencesShirazIran
| | - Reza Taheri
- Department of NeurosurgeryShiraz University of Medial SciencesShirazIran
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Dezawa T, Hasegawa K, Tsuge S, Wada A, Takahashi H. A Case of Idiopathic Thoracic Spinal Subdural Hematoma With Bilateral Lower Limb Paralysis. Cureus 2021; 13:e16585. [PMID: 34430177 PMCID: PMC8378316 DOI: 10.7759/cureus.16585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2021] [Indexed: 12/02/2022] Open
Abstract
Subdural hemorrhage is rare and is mostly triggered non-traumatically due to intracranial surgery, lumbar puncture, anticoagulant therapy, blood diseases, vascular malformations, and tumors. We experienced a case of idiopathic subdural hematoma with acute bilateral lower limb paralysis on postoperative day 4 after laparoscopic hysteromyomectomy. The patient was a 40-year-old woman with uterine myoma who took no medication nor had history of trauma or abnormalities such as vascular malformations. Four days after laparoscopic surgery, sudden chest and back pain and bilateral lower limb paralysis appeared. Muscle weakness was found predominantly on the left side. In manual muscle test (MMT), the quadriceps femoris was 5/5 on both sides, but the tibialis anterior, extensor pollicis longus and flexor pollicis longus were 5/5 only on the right, and 2/5 on the left side. Warm pain sensation was decreased below Th4 (Fourth thoracic vertebra), and the right side showed a greater decrease of deep sensation than the left. Excretion was difficult and dysuria was also apparent. There were no abnormalities in blood biochemical tests or in the blood coagulation system. Using the results of diagnostic imaging, as preoperative diagnosis of the patient, spinal subdural hematoma was suspected. Conservative treatment was initially conducted but the emergency surgery for hematoma removal was performed at 14 hours after the onset because of progression of paralysis. This resulted in improvement of neurological symptoms including lower limb paralysis, bladder-rectal disorder and hypoesthesia. If subdural hematoma is suspected regardless of the cause, it is important to observe neurological findings over time and make a quick decision to treat with surgery.
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Affiliation(s)
- Takashi Dezawa
- Department of Orthopaedic Surgery, Toho University School of Medicine, Tokyo, JPN
| | - Keiji Hasegawa
- Department of Orthopaedic Surgery, Toho University School of Medicine, Tokyo, JPN
| | - Shintarou Tsuge
- Department of Orthopaedic Surgery, Toho University School of Medicine, Tokyo, JPN
| | - Akito Wada
- Department of Orthopaedic Surgery, Toho University School of Medicine, Tokyo, JPN
| | - Hiroshi Takahashi
- Department of Orthopaedic Surgery, Toho University School of Medicine, Tokyo, JPN
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Acute idiopathic spinal subdural hematoma: What to do in an emergency? Neurochirurgie 2019; 65:93-97. [DOI: 10.1016/j.neuchi.2018.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 08/16/2018] [Accepted: 10/06/2018] [Indexed: 11/20/2022]
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Wang B, Liu W, Zeng X. Idiopathic cervical spinal subdural haematoma: a case report and literature review. J Int Med Res 2019; 47:1365-1372. [PMID: 30761926 PMCID: PMC6421387 DOI: 10.1177/0300060519829666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
This report describes a case of idiopathic cervical spinal subdural haematoma
(SSDH) in which the haematoma was spontaneously absorbed without any treatment.
A 68-year-old male patient presented with persistent neck pain and no obvious
cause. Magnetic resonance imaging (MRI) revealed a space-occupying lesion at the
C4–T1 levels. The lesion was initially misdiagnosed as a tumour. An operation
was arranged to remove the tumour, but a preoperative computed tomography scan
showed no obvious abnormal soft tissue density in the cervical spinal canal.
Repeat enhanced MRI showed degeneration of the cervical vertebrae, but no
obvious abnormal soft tissue density and no obvious enhanced signals in the
cervical spinal canal. Spontaneous resolution of an idiopathic cervical SSDH was
considered. Idiopathic cervical SSDH without obvious neurological symptoms are
difficult to diagnose, so suspected cases should be carefully monitored. If the
neurological symptoms grow progressively more debilitating with time, emergency
surgery might need to be considered. To avoid unnecessary surgery, conservative
management should be an option for patients with minimal neurological deficits
and re-examination with MRI could be the best way to observe the dynamic changes
taking place in the idiopathic cervical SSDH.
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Affiliation(s)
- Bingjin Wang
- 1 Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.,*These authors contributed equally to this work
| | - Weifang Liu
- 2 Department of Obstetrics and Gynaecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.,*These authors contributed equally to this work
| | - Xianlin Zeng
- 1 Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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Wang Y, Zheng H, Ji Y, Lu Q, Li X, Jiang X. Idiopathic Spinal Subdural Hematoma: Case Report and Review of the Literature. World Neurosurg 2018; 116:378-382. [DOI: 10.1016/j.wneu.2018.05.155] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/20/2018] [Accepted: 05/22/2018] [Indexed: 12/29/2022]
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Treatment of hematomas after anterior cervical spine surgery: A retrospective study of 15 cases. Neurochirurgie 2018; 64:166-170. [PMID: 29735379 DOI: 10.1016/j.neuchi.2017.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 12/21/2017] [Accepted: 12/29/2017] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Postoperative hematoma is a rare and dangerous complication of cervical spine surgery. The aim of this study was to investigate the incidence and related factors of postoperative hematoma, and to report on 15 cases at our institution over a 6-year period. METHODS Fifteen cases of postoperative hematoma were retrospectively identified. We investigated their neurological outcomes, characteristics, and surgical data, and identified risk factors associated with postoperative (PO) hematoma. Patients with hematoma were compared to those with no hematoma, in order to identify risk factors. RESULTS Retropharyngeal hematomas developed in seven cases and epidural hematomas in eight. The total incidence of postoperative hematoma was 1.2%: 0.5% retropharyngeal hematomas and 0.6% spinal epidural hematomas. At time of onset, the severity of paralysis was assessed as grade B in one case, grade C in six cases, and grade D in eight cases. Risk factors for PO hematoma were: (1) presence of ossification of the posterior longitudinal ligament (OPLL) (P<0.001); (2) longer operative duration (P=0.048); (3) greater number of surgical levels (P=0.02); and (4) higher body mass index (BMI; P=0.035). There was no significant difference in modified Japan Orthopedic Association scores between the hematoma group and non-hematoma group (P>0.05). CONCLUSION Precise preoperative preparation and systematic evaluation are central to successful management of PO hematoma after anterior cervical surgery. Risk factors for PO hematoma include multilevel decompression, OPLL, higher BMI, and longer operation time.
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Acute, Nontraumatic Spontaneous Spinal Subdural Hematoma: A Case Report and Systematic Review of the Literature. Case Rep Neurol Med 2017; 2017:2431041. [PMID: 29441210 PMCID: PMC5758945 DOI: 10.1155/2017/2431041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 12/04/2017] [Indexed: 12/03/2022] Open
Abstract
Spontaneous spinal subdural hematoma (sSDH) is a rare condition outright. Moreover, cases that occur spontaneously in the absence of an identifiable etiology are considerably less common and remain poorly understood. Here, we present the case of a 43-year-old man with spontaneous sSDH presenting with acute onset low back pain and paraplegia. Urgent magnetic resonance imaging identified a dorsal SDH from T8 to T11 with compression of the spinal cord. Emergent T8–T10 laminectomies with intradural exploration and hematoma evacuation were performed. However, despite prompt identification and appropriate action, the patient's recovery was modest and significant disability remained at discharge. This unique and unusual case demonstrates that spontaneous sSDH requires prompt surgical treatment to minimize associated morbidity and supports the association between the presence of severe neurological deficits upon initial presentation with less favorable outcomes. We performed a comprehensive systematic review of spontaneous sSDH of unknown etiology, which demonstrates that emergent surgical intervention is indicated for patients presenting with severe neurological deficits and the presence of these deficits is predictive of poor neurological outcome. Furthermore, conservative management should be considered in patients presenting with mild neurological deficits as spontaneous resolution followed by favorable neurological outcomes is often observed in these patients.
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10
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Pereira BJA, de Almeida AN, Muio VMF, de Oliveira JG, de Holanda CVM, Fonseca NC. Predictors of Outcome in Nontraumatic Spontaneous Acute Spinal Subdural Hematoma: Case Report and Literature Review. World Neurosurg 2016; 89:574-577.e7. [DOI: 10.1016/j.wneu.2015.11.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 11/06/2015] [Accepted: 11/06/2015] [Indexed: 12/19/2022]
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Syringomyelia following surgery for a spontaneous spinal subdural hematoma in a 13-year-old girl with congenital von Willebrand disease: case report and literature review. Childs Nerv Syst 2016; 32:727-31. [PMID: 26277360 DOI: 10.1007/s00381-015-2875-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 08/06/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND IMPORTANCE Spontaneous spinal subdural hematomas are rare. Their occurrence in a child with congenital von Willebrand disease and the complication of their surgery by a large secondary syringomyelia have never been previously reported. CASE PRESENTATION A 13-year-old girl with congenital von Willebrand disease presented to our emergency department in January 2011 for sudden onset of severe back pain centered in her thoracic spine rapidly aggravated by signs of acute myelopathy without any precipitating factor. MRI scan revealed a thoracic subdural collection anterior to the spinal cord at the T7-T9 level, hyperintense on T1- and T2-weighted sequences consistent with an acute spinal subdural hemorrhage. Evacuation of the subdural hematoma was realized immediately after hemostasis parameter correction, and post-operative course was uneventful with full functional recovery. One year later, the patient presented once again but with progressive and more severe myelopathy caused by a large syringomyelia extending from the T5 level to the conus medullaris. A syringopleural shunting was performed and the patient was unrolled under an intensive care and rehabilitation program. Her condition remarkably improved and she became able to walk independently within 2 weeks post-operatively. CONCLUSIONS von Willebrand disease should be included as a possible factor of spontaneous spinal subdural hemorrhage. Surgery is advised in emergency and can be associated with remarkable recovery especially in children. Delayed syringomyelia can complicate the post-operative course and can be successfully addressed by syringopleural shunting. Long-term clinical and radiological follow-up is advocated.
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Lee JH, Park KS, Lee DS, Park MS. Spontaneous Spinal Subdural Hematoma causing Brown-Séquard Syndrome with Thrombocytopenic Myelodysplastic Syndrome. KOREAN JOURNAL OF SPINE 2015; 12:213-6. [PMID: 26512288 PMCID: PMC4623188 DOI: 10.14245/kjs.2015.12.3.213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 07/29/2015] [Accepted: 08/10/2015] [Indexed: 11/19/2022]
Abstract
Spontaneous spinal subdural hematoma (SSDH) is a very rare condition. We report a case of SSDH presenting with Brown-Séquard syndrome, treated by surgical evacuation. A 77-year-old woman was hospitalized for back pain without trauma history. As she showed progressive sensory loss and right-side dominant paraparesis, we performed magnetic resonance imaging and confirmed the SSDH in the thoracic area. Therefore, she underwent emergent operation and the hematoma was evacuated successfully. After the operation, the patient showed improvement in neurologic function.
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Affiliation(s)
- Jong Hyeok Lee
- Department of Neurosurgery, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea
| | - Ki Suk Park
- Department of Neurosurgery, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea
| | - Do Sung Lee
- Department of Neurosurgery, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea
| | - Mun Sun Park
- Department of Neurosurgery, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea
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Zhu YJ, Peng DQ, Shen F, Wang LL, Tang ZX, Zhang JM. Spontaneous thoracic ventral spinal subdural hematoma mimicking a tumoral lesion: a case report. J Med Case Rep 2015; 9:132. [PMID: 26048171 PMCID: PMC4470086 DOI: 10.1186/s13256-015-0562-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 03/03/2015] [Indexed: 11/12/2022] Open
Abstract
Introduction Spinal subdural hematoma is rare and can cause serious neurological symptoms. Sometimes, idiopathic spinal subdural hematoma can spontaneously occur without any identifiable underlying etiologies. In this report, we present such an uncommon case of paraplegia caused by idiopathic spinal subdural hematoma that was successfully managed by laminectomy. Case presentation A 45-year-old Chinese woman presented with sudden onset of progressive asthenia and numbness in both lower extremities, accompanied by difficulty in micturition. An initial non-contrast spinal magnetic resonance imaging at a local hospital suggested a spinal subdural tumoral hematoma at the T9 level. She was referred to our hospital and an emergency laminectomy from T8 to T10 was performed 22 hours after onset of her initial symptoms. However, nothing but a hematoma was identified during the operation, and a final diagnosis of spontaneous acute spinal subdural hematoma was concluded. She had partial return of sensations and voluntary movement after the operation. Conclusions On imaging findings, spinal subdural hematoma could manifest as focal and independent from the dura matter, and, therefore, it should be included in the differential diagnosis of medullary compressive lesions.
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Affiliation(s)
- Yong-Jian Zhu
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China.
| | - De-Qing Peng
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China.
| | - Fang Shen
- Department of Neurosurgery, Ningbo No.2 Hospital, Ningbo, Zhejiang, 315010, China.
| | - Lin-Lin Wang
- Department of Physiology, Zhejiang University School of Medicine, Hangzhou, 310009, China.
| | - Zhu-Xiao Tang
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China.
| | - Jian-Min Zhang
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China.
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Dziedzic T, Kunert P, Krych P, Marchel A. Management and neurological outcome of spontaneous spinal epidural hematoma. J Clin Neurosci 2015; 22:726-9. [PMID: 25677879 DOI: 10.1016/j.jocn.2014.11.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 10/28/2014] [Accepted: 11/02/2014] [Indexed: 12/14/2022]
Abstract
This study assesses the etiology, clinical management, and outcome of patients with spontaneous spinal epidural hematoma (SSEH). SSEH is an uncommon neurosurgical emergency. We analyzed data from 10 patients (six women, four men) treated for SSEH (mean age, 63.5 years). Five patients had bleeding disorders due to anticoagulant therapy at the time of diagnosis. The initial clinical symptom in most patients was severe pain (n=8). Spinal injury was assessed using the American Spinal Injury Association (ASIA) scale, with six Grade A, one Grade C, and three Grade D patients. Lesions were in the cervicothoracic (n=4), thoracic (n=5), and thoracolumbar regions (n=1). Location was dorsal in seven patients and ventral in three. SSEH extension ranged from three to 15 spinal levels (mean, 6.9 levels). ASIA scale outcomes for the entire group were Grade A, n=2; Grade B, n=1; Grade C, n=1; Grade D, n=2; and Grade E, n=4. Outcomes for patients with no bleeding disorders (n=5) were Grade D, n=1; and Grade E, n=4. Outcomes for patients with bleeding disorders (n=5) were Grade A, n=2; Grade B, n=1; Grade C, n=1; and Grade D, n=1. After surgical treatment, patients improved by at least by one ASIA grade. The patients with mild neurological deficit who were treated conservatively also improved. Emergent spinal cord decompression is the only way to preserve spinal cord function in patients with severe deficit. Coagulation disorders were related to poor neurological status at admission and with poor neurological outcome. Conservative treatment was acceptable in patients with minimal neurological deficit.
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Affiliation(s)
- Tomasz Dziedzic
- Department of Neurosurgery, Medical University of Warsaw, 02-097 Warszawa, Banacha 1a, Poland.
| | - Przemysław Kunert
- Department of Neurosurgery, Medical University of Warsaw, 02-097 Warszawa, Banacha 1a, Poland
| | - Piotr Krych
- Department of Neurosurgery, Medical University of Warsaw, 02-097 Warszawa, Banacha 1a, Poland
| | - Andrzej Marchel
- Department of Neurosurgery, Medical University of Warsaw, 02-097 Warszawa, Banacha 1a, Poland
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Acute spinal subdural hematoma after vigorous back massage: a case report and review of literature. Spine (Phila Pa 1976) 2014; 39:E1545-8. [PMID: 25271505 DOI: 10.1097/brs.0000000000000629] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A case report and review of literature. OBJECTIVE We report on a patient with traumatic spinal subdural hematoma after vigorous back massage while on vacation. SUMMARY OF BACKGROUND DATA Traumatic spinal subdural hematoma is extremely rare, and to our knowledge, this is the first case reported after violent back massage. We emphasize a high index of suspicion for early recognition and treatment for a good neurological recovery. METHODS A 41-year-old male was brought to our hospital with severe back pain, motor and sensory impairments of the bilateral lower extremities, and urinary dysfunction after vigorous back massage. Magnetic resonance images revealed an acute spinal subdural hematoma in the thoracolumbar region. After careful monitoring of his neurological status, the patient was successfully managed with conservative treatment. RESULTS After 2 weeks of hospitalization, complete motor power recovery was achieved with only minor sensory deficit. At a follow-up of more than 12 months, the patient has no residual neurological deficits. CONCLUSION Spinal subdural hematoma secondary to physical trauma is quite rare. This case brings new information that traumatic spinal subdural hematoma can be caused by violent massage. LEVEL OF EVIDENCE N/A.
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Acute spinal subdural hematoma with hemiplegia after acupuncture: a case report and review of the literature. Spine J 2013; 13:e59-63. [PMID: 24094991 DOI: 10.1016/j.spinee.2013.06.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 03/13/2013] [Accepted: 06/01/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Subdural spinal hematoma (SDH) is a very rare entity; however, it can lead to serious complications resulting from injuries to the spinal cord and roots. Although acupuncture has been a popular method for the management of pain control, we encountered the first case of SDH after acupuncture. PURPOSE The purpose of this case report was to present the first case of subdural hematoma after acupuncture and the reasons for the risks of blind cervical acupuncture. STUDY DESIGN A case report and review of the previous literature are presented. METHODS A 69-year-old man complained of progressive weakness in the right upper and lower extremities 2 hours after acupuncture on the cervical spine and back. The diagnosis was delayed because of unilateral weakness, and the symptom was initially misinterpreted as a transient ischemic attack because of no sensory change and pain and normal findings of two brain magnetic resonance imaging (MRI). RESULTS Cervical MRI 36 hours after onset revealed acute hematoma from the C3-C5 level; hematoma showed an isointensity on T1-weighted image (WI) with the preservation of epidural fat and a hypointensity on T2WI. A decompressive surgery was scheduled to perform within 2 days after the cervical MRI scan because of a previous anticoagulation therapy, but the patient refused it. Finally, 9 days after the onset, surgical decompression and removal of hematoma were performed. Three months postoperatively, the patient had fully recovered demonstrating fine hand movement and good ability to walk up and down the stairs. CONCLUSIONS Our study indicates that it is essential to perform cervical MRI when a patient does not show an improvement in the neurologic deficit and has a negative brain MRI after acupuncture. In addition, blind acupuncture if not correctly practiced may be harmful to the cervical structures.
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