Kim Tackeun, Lee Chang-Hyun, Hyun Seung-Jae, Yoon Sang Hoon, Kim Ki-Jeong, Kim Hyun-Jib
Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
J Korean Neurosurg Soc. 2012 Dec;52(6):523-7. doi: 10.3340/jkns.2012.52.6.523. Epub 2012 Dec 31.
The incidence of spontaneous spinal epidural hematoma (SSEH) is rare. Patients with SSEH, however, present disabling neurologic deficits. Clinical outcomes are variable among patients. To evaluate the adequate treatment method according to initial patients' neurological status and clinical outcome with comparison of variables affecting the clinical outcome.
We included 15 patients suffered from SSEH. Patients were divided into two groups by treatment method. Initial neurological status and clinical outcomes were assessed by the American Spinal Injury Association (ASIA) impairment scale. Also sagittal hematoma location and length of involved segment was analyzed with magnetic resonance images. Other factors such as age, sex, premorbid medication and duration of hospital stay were reviewed with medical records. Nonparametric statistical analysis and subgroup analysis were performed to overcome small sample size.
Among fifteen patients, ten patients underwent decompressive surgery, and remaining five were treated with conservative therapy. Patients showed no different initial neurologic status between treatment groups. Initial neurologic status was strongly associated with neurological recovery (p=0.030). Factors that did not seem to affect clinical outcomes included : age, sex, length of the involved spinal segment, sagittal location of hematoma, premorbid medication of antiplatelets or anticoagulants, and treatment methods.
For the management of SSEH, early decompressive surgery is usually recommended. However, conservative management can also be feasible in selective patients who present neurologic status as ASIA scale E or in whom early recovery of function has initiated with ASIA scale C or D.
自发性脊髓硬膜外血肿（SSEH）的发病率很低。然而，SSEH患者会出现致残性神经功能缺损。患者的临床结局各不相同。根据患者的初始神经状态和临床结局评估适当的治疗方法，并比较影响临床结局的变量。
我们纳入了15例SSEH患者。根据治疗方法将患者分为两组。采用美国脊髓损伤协会（ASIA）损伤量表评估初始神经状态和临床结局。同时，利用磁共振图像分析矢状位血肿位置和受累节段长度。通过病历回顾其他因素，如年龄、性别、病前用药情况和住院时间。进行非参数统计分析和亚组分析以克服样本量小的问题。
15例患者中，10例接受了减压手术，其余5例接受了保守治疗。两组患者的初始神经状态无差异。初始神经状态与神经功能恢复密切相关（p = 0.030）。似乎不影响临床结局的因素包括：年龄、性别、脊髓受累节段长度、血肿矢状位位置、抗血小板或抗凝剂的病前用药情况以及治疗方法。
对于SSEH的治疗，通常建议早期进行减压手术。然而，对于神经状态为ASIA E级的选择性患者或神经功能已从ASIA C级或D级开始早期恢复的患者，保守治疗也是可行的。
