Spinal epidural hematoma is a rare condition. Because the etiology is often unclear and the medical history is frequently innocuous, a high index of suspicion is required in order to maximize the chances of a successful outcome.
This month’s “Case Connections” spotlights 4 cases of spinal epidural hematoma involving 2 elderly women, a male Olympic-caliber swimmer, and a preadolescent boy.
In the springboard case, from the March 22, 2017, edition of JBJS Case Connector, Yamaguchi et al. report on a 90-year-old woman with a history of transient ischemic attacks (TIAs) and combined aspirin-dipyridamole therapy in whom a large spontaneous spinal epidural hematoma (SSEH) developed rapidly after she shifted her position in bed. The authors concluded that their case emphasized that “early diagnosis of an SSEH and prompt surgical intervention can avoid catastrophic and permanent neurological deterioration and compromise.”
Three additional JBJS Case Connector case reports summarized in the article focus on:
- An 82-year-old woman who developed an epidural hemorrhage and acute paraplegia following vertebroplasty
- A 22-year-old male collegiate swimmer who underwent an emergent operative spinal decompression procedure within 4 hours after presentation to the ED with searing back pain and decreased leg strength
- A 12-year-old boy who presented to the hospital with intense back pain along with numbness, tingling, and loss of motor function in the lower extremities 3 weeks after he had been pushed into a wall at school
Among the take-home points from this “Case Connections” article: MRI is the gold standard for the diagnosis of spinal epidural hematomas, and treatment typically involves operative decompression consisting of laminectomies and evacuation of the hematoma.
The November 25, 2015 “Case Connections” looks at four JBJS Case Connector cases involving injuries to the cervical spine in which the outcomes were about as good as anyone could have wished, considering the potential for disaster. Two of the cases required surgical intervention to achieve the positive outcomes, but the outcomes in the other two cases were remarkably positive without surgery.
While these four cases of cervical spine injury had relatively “happy endings,” orthopaedic surgeons and other health-care professionals treating patients with any suspected spine injury are trained to proceed with the utmost care and caution out of concern for devastating neurological sequelae. Watchful waiting under close medical scrutiny is sometimes warranted, but many cases of cervical fracture, dislocation, or instability call for operative stabilization to reduce the risk of life-changing or life-threatening consequences. The potential seriousness of surgical complications when operating on the spine must also be recognized.