Division of Spinal Surgery, Oxford University NHS Foundation Trust, Oxford, England, UK.
Paediatric Department, Oxford University NHS Foundation Trust, Oxford, England, UK.
Eur Spine J. 2019 Oct;28(10):2229-2236. doi: 10.1007/s00586-019-05975-6. Epub 2019 Apr 10.
To understand the typical presentation, risk factors, location and size, treatment, neurological recovery and survival of spontaneous spinal epidural haematomas (SSEH) in children.
A systematic review of the English literature from 1 January 1960 to 1 March 2018 was performed on children aged 18 years and younger. Individual patient data were extracted and collated. Outcome measures were mode of presentation, risk factors, initial neurological findings, initial presumed diagnosis, diagnostic investigations, site and size of the SSEH, treatment, neurological recovery and survival.
Thirty-one publications and 36 patients were reviewed. All age groups were affected. 83% of patients did not have a known risk factor. Back pain was reported in 61% and neurological dysfunction in 97% of patients, although not all articles defined these parameters. Initially 28% of patients were suspected of having an alternative diagnosis. All patients had an MRI and/or CT scan confirming the diagnosis. The cervical-thoracic region was most commonly affected, and the average haematoma size extended across 6.3 vertebral levels. Surgical decompression was performed in 72% of patients. Neurological function improved in 83% of patients. Two patients died as a consequence of their SSEH.
SSEHs affect all paediatric age groups and typically present with neurological dysfunction and/or back pain. The initial diagnosis is incorrect in up to 28% of cases, but cross-sectional spinal imaging is diagnostic. Most SSEHs are located in the cervico-thoracic region and affect multiple spinal levels. The treatment depends on whether the patient has a bleeding disorder and their neurological status. These slides can be retrieved under Electronic Supplementary Material.
了解儿童自发性脊髓硬膜外血肿（SSEH）的典型表现、危险因素、部位和大小、治疗、神经恢复和存活率。
对 1960 年 1 月 1 日至 2018 年 3 月 1 日期间的英文文献进行了系统回顾，纳入年龄在 18 岁及以下的儿童患者。提取并整理了患者的个体数据。观察指标为表现形式、危险因素、初始神经学发现、初始推测诊断、诊断性检查、SSEH 的部位和大小、治疗、神经恢复和存活率。
共 31 篇文献和 36 例患者纳入分析。所有年龄段的儿童均受到影响。83%的患者无已知危险因素。61%的患者有背痛，97%的患者有神经功能障碍，尽管并非所有文章都对这些参数进行了定义。最初有 28%的患者被怀疑患有其他诊断。所有患者均行 MRI 和/或 CT 扫描以明确诊断。最常见的病变部位为颈胸段，血肿平均跨 6.3 个椎体水平。72%的患者行手术减压。83%的患者神经功能得到改善。有 2 例患者因 SSEH 死亡。
SSEH 可影响所有儿科年龄段的儿童，其典型表现为神经功能障碍和/或背痛。初始诊断错误率高达 28%，但脊髓横断面影像学检查可明确诊断。大多数 SSEH 位于颈胸段，影响多个脊髓节段。治疗取决于患者是否存在出血性疾病及其神经状态。这些幻灯片可以在电子补充材料中检索到。
