Kim Dong Hwan, Kim Dong Ha, Nam Kyoung Hyup, Choi Byung Kwan, Han In Ho
Department of Neurosurgery & Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
Korean J Spine. 2017 Sep;14(3):96-98. doi: 10.14245/kjs.2017.14.3.96. Epub 2017 Sep 30.
Although the etiology of spontaneous spinal epidural hematoma (SSEH) is unclear, SSEH is known to be associated with anticoagulants, coagulopathy, vascular malformation, hypertension, and pregnancy. However, no report has been issued on the relation between SSEH and venous phlebolith. Here, the authors present an extremely rare case of SSEH associated with phlebolith in the cervical spine and suggest a possible pathogenesis. A 36-year-old man without any relevant medical history presented with neck pain and numbness and severe radiating pain on the left arm. Magnetic resonance imaging showed epidural hematoma at the C5-7 level, and computed tomography revealed a calcified nodule in the left epidural hemorrhage at C6 level. During left partial laminectomy, epidural venous plexus, and thick epidural hematoma were found, and hematoma removal revealed a white, ovoid, smooth, hard mass of diameter 3 mm. Histopathologic examination confirmed the mass as a venous phlebolith. The presence of a calcified solitary nodule in dorsal epidural space indicates the presence of phlebolith and the risk of SSEH. In such cases, the authors recommend spine surgeons should take into consideration the possibility of epidural hemorrhage.
尽管自发性脊髓硬膜外血肿（SSEH）的病因尚不清楚，但已知SSEH与抗凝剂、凝血功能障碍、血管畸形、高血压及妊娠有关。然而，尚无关于SSEH与静脉石之间关系的报道。在此，作者报告了1例极其罕见的颈椎SSEH合并静脉石的病例，并提出了可能的发病机制。1例无相关病史的36岁男性，出现颈部疼痛、麻木及左臂严重放射性疼痛。磁共振成像显示C5-7水平硬膜外血肿，计算机断层扫描显示C6水平左侧硬膜外出血处有一钙化结节。在左侧部分椎板切除术中，发现硬膜外静脉丛及厚厚的硬膜外血肿，清除血肿后发现一个直径3 mm的白色、卵圆形、光滑、坚硬的肿块。组织病理学检查证实该肿块为静脉石。背侧硬膜外间隙存在钙化孤立结节提示静脉石的存在及SSEH的风险。在此类病例中，作者建议脊柱外科医生应考虑硬膜外出血的可能性。
