Ramírez Villaescusa José, Restrepo Pérez Marcela, Ruiz Picazo David
Spine Unit, Department of Orthopaedic Surgery, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.
Geriatr Orthop Surg Rehabil. 2017 Mar;8(1):18-22. doi: 10.1177/2151458516681633. Epub 2016 Dec 14.
Spinal epidural hematoma (SEH) is a rare disease that causes cord compression and neurologic deficit. Spontaneous SEH is related to minor trauma, bleeding disorders, and anticoagulant medications. Posttraumatic SEH has been associated with low-energy spine hyperextension injuries in patients with ankylosing spinal disorders such as ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis (DISH). A variant named atypical DISH-like with SEH is reported.
To describe the management, diagnosis, and treatment of an unusual SEH case in a patient causing delayed neurologic deficit with rigid atypical DISH-like spine.
An elderly woman with prior antiplatelet therapy presented with delayed neurological deficit suffering trauma after falling. Computed tomography (CT) imaging studies reveal hyperextension fracture pattern and signs mimic DISH missed on standard X-ray images. Magnetic resonance (MR) study demonstrates posterior epidural mass compatible with SEH in thoracic spine with cord compression. Using a midline posterior approach, an urgent intervention and a left multiple partial unilateral decompressive laminectomy at T4-T7 and a long instrumented fusion at T3-T9 were performed for achieving spinal stability and neurological improvement, both of which were observed.
Patients with rigid spine who sustain low-energy injuries may be prone to have a fracture and epidural hematoma, especially if they take anticoagulant medications. Imaging studies including MR and CT scans should be reviewed carefully to rule out any occult fracture. Urgent or early surgical hematoma drainage and instrumented fusion must be performed to achieve stability and functional recovery.
脊髓硬膜外血肿（SEH）是一种罕见疾病，可导致脊髓受压和神经功能缺损。自发性SEH与轻微创伤、出血性疾病及抗凝药物有关。创伤后SEH与强直性脊柱炎和弥漫性特发性骨肥厚（DISH）等强直性脊柱疾病患者的低能量脊柱过伸损伤有关。据报道有一种名为非典型DISH样伴SEH的变异型。
描述一例不寻常的SEH病例的处理、诊断和治疗，该病例导致具有僵硬非典型DISH样脊柱的患者出现延迟性神经功能缺损。
一名曾接受抗血小板治疗的老年女性，跌倒后出现延迟性神经功能缺损并伴有创伤。计算机断层扫描（CT）成像研究显示过伸骨折模式，其征象在标准X线图像上类似DISH但被漏诊。磁共振（MR）研究显示胸椎后硬膜外肿块，与SEH相符，伴有脊髓受压。采用后正中入路，进行了紧急干预，在T4 - T7行左侧多处部分单侧减压椎板切除术，并在T3 - T9行长节段器械辅助融合术，以实现脊柱稳定和神经功能改善，二者均得以观察到。
脊柱僵硬且遭受低能量损伤的患者可能易于发生骨折和硬膜外血肿，尤其是在服用抗凝药物的情况下。应仔细审查包括MR和CT扫描在内的影像学研究，以排除任何隐匿性骨折。必须进行紧急或早期手术血肿引流及器械辅助融合术，以实现稳定和功能恢复。
