Liao Cheng-Chih, Hsieh Po-Chuan, Lin Tzu-Kang, Lin Chih-Lung, Lo Yang-Lan, Lee Sai-Cheung
Department of Neurosurgery, Chang Gung University and Chang Gung Memorial Hospital, Kweishan, Taoyuan, Taiwan.
J Neurosurg Spine. 2009 Oct;11(4):480-6. doi: 10.3171/2009.4.SPINE08904.
Spontaneous spinal epidural hematoma (SSEH) is a rare disease. The goal of this study was to clarify the treatment results and management options in SSEH.
Patients with SSEH who were surgically treated in the authors' center between June 2003 and June 2008 were included in this study. Patients were treated as early as possible if their neurological deficits were incomplete or had been complete for 12 hours or less. The patients were assigned to 1 of 2 groups based on completeness of preoperative cord dysfunction (complete vs incomplete deficit). Surgical outcomes of the 2 groups were compared by functional performance, coded as Nurick grades at 1, 3, and 6 months after the operation. Also compared were duration of hospital stay and the number of days needed to regain the ability to function independently (defined as Nurick Grades 1 and 2) after the operation.
There were 17 patients (7 female and 10 male) with pathologically confirmed SSEH. Coagulopathy, greater size (length) of SSEH, and preoperative complete spinal dysfunction were found to contribute to poor postoperative functional recovery (p < 0.05). Patients with incomplete preoperative deficits (ASIA Impairment Scale Grades B, C, and D) were able to achieve functional independent recovery within a month after surgery and had significantly better outcomes (lower Nurick grades) at 1, 3, and 6 months postoperatively than those with complete deficits (p < 0.001, p = 0.027, and p = 0.027, respectively). Median time to independent functional recovery and median length of hospital stay were significantly shorter in patients with incomplete preoperative deficits than in those with complete deficits (6 vs 110 and 9 vs 58 days, respectively; both p < 0.001).
Impaired preoperative hemostasis contributes to larger size of SSEH, high probability of postoperative recurrence of spinal epidural hematoma, and poor functional recovery following surgical evacuation. Incomplete spinal cord dysfunction before surgery predicts good outcome and warrants emergent evacuation of SSEH especially in the cervical and thoracic regions, where the clots are located in proximity to the spinal cord.
自发性脊髓硬膜外血肿（SSEH）是一种罕见疾病。本研究的目的是阐明SSEH的治疗结果及处理方法。
本研究纳入了2003年6月至2008年6月间在作者所在中心接受手术治疗的SSEH患者。如果患者神经功能缺损不完全或完全缺损持续时间在12小时及以内，则尽早进行治疗。根据术前脊髓功能障碍的完整性（完全性缺损与不完全性缺损）将患者分为两组。通过功能表现比较两组的手术结果，功能表现用术后1、3和6个月时的Nurick分级表示。同时比较两组的住院时间以及术后恢复独立功能（定义为Nurick分级1级和2级）所需的天数。
有17例经病理证实的SSEH患者（7例女性，10例男性）。发现凝血功能障碍、SSEH更大的尺寸（长度）以及术前完全性脊髓功能障碍会导致术后功能恢复不佳（p < 0.05）。术前缺损不完全的患者（美国脊髓损伤协会损伤分级B、C和D级）术后1个月内能够实现功能独立恢复，且术后1、3和6个月时的结果（Nurick分级更低）明显优于术前缺损完全的患者（分别为p < 0.001、p = 0.027和p = 0.027）。术前缺损不完全的患者恢复独立功能的中位时间和住院中位时间明显短于术前缺损完全的患者（分别为6天对110天和9天对58天；均p < 0.001）。
术前止血功能受损会导致SSEH尺寸增大、脊髓硬膜外血肿术后复发概率高以及手术清除血肿后功能恢复不佳。术前脊髓功能障碍不完全预示着良好的预后，并且有必要紧急清除SSEH，尤其是在血块位于脊髓附近的颈段和胸段。
