From the Department of Neurosurgery (D.P., T.L., X.H., G.Y., Y.Z.), The 2nd Affiliated Hospital of Zhejiang University, Hangzhou; Center for Rehabilitation Medicine (D.P., K.Y., Y.M.), Department of Neurosurgery, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College); Clinical Research Center for Neurological Diseases of Zhejiang Province (D.P., T.L., X.H., G.Y., Y.Z.), Hangzhou; Department of Neurosurgery (M.Y.), The 1st Affiliated Hospital of Zhejiang University, Hangzhou, China.
Neurology. 2022 Aug 23;99(8):e843-e850. doi: 10.1212/WNL.0000000000200844. Epub 2022 Jun 17.
Spontaneous spinal epidural hematoma (SSEH) is an uncommon but serious condition with a high morbidity rate. Although SSEH is related to numerous risk factors, its etiology remains unclear. There is a paucity of data on its prognostic factors. We aim to evaluate prognostic factors for SSEH in this study.
A retrospective study was performed on patients who were admitted for SSEH in 3 academic neurosurgical centers from January 2010 to June 2021. Clinical parameters, including clinical condition on admission, anticoagulants use, imaging modality, the timing and type of surgery performed, and outcomes, were collected. Prognostic factors were analyzed. The Frankel scale was used to assess the clinical condition.
A total of 105 patients with SSEH were retrieved from medical records, with a mean age of 51.3 years. Eighty-three patients (79%) complained of acute onset of severe neck or back pain. Eighty-two patients (78%) suffered from moderate to severe neurologic deficits (Frankel scale A-C). Anticoagulation usage was found in 20% of cases. Lower thoracic spine ( = 0.046), use of anticoagulants ( = 0.019), sphincter function disfunction ( = 0.008), severe neurologic deficits at admission ( < 0.001), and rapid deterioration (<1 hour, = 0.004) were found to be associated with poor outcomes. Surgical decompression was performed in 74 (70%) cases. The univariate and multivariate analysis revealed that preoperative severe neurologic deficits ( = 0.005) and extended paraplegia time (>12 hours, = 0.004) were independent adverse prognostic factors. The univariate analysis revealed that lower thoracic spine location ( = 0.08) and rapid progression (<6 hours, = 0.005) were correlated with poor prognosis, but the multivariate analysis failed to identify them as independent prognostic factors.
Adverse prognostic factors for SSEH might include thoracic segment location, use of anticoagulation, severe neurologic deficits on admission, sphincter dysfunction, and rapid progression. Preoperative neurologic deficit and extended paraplegia time were strongly correlated with the prognosis in the subset of patients who underwent surgical decompression. Timely surgical decompression is recommended for patients with moderate/severe neurologic deficits or progressive neurologic deterioration.
自发性脊柱硬膜外血肿（SSEH）是一种少见但严重的疾病，发病率较高。尽管 SSEH 与许多危险因素有关，但病因仍不清楚。关于其预后因素的数据很少。本研究旨在评估 SSEH 的预后因素。
对 2010 年 1 月至 2021 年 6 月在 3 个学术神经外科中心因 SSEH 住院的患者进行回顾性研究。收集了包括入院时临床状况、抗凝药物使用、影像学方式、手术时机和类型以及结果在内的临床参数。分析了预后因素。采用 Frankel 量表评估临床状况。
从病历中检索到 105 例 SSEH 患者，平均年龄为 51.3 岁。83 例（79%）患者诉急性剧烈颈或背痛。82 例（78%）患者有中度至重度神经功能缺损（Frankel 量表 A-C）。20%的病例使用了抗凝药物。下胸椎（=0.046）、使用抗凝药物（=0.019）、括约肌功能障碍（=0.008）、入院时严重神经功能缺损（<0.001）和快速恶化（<1 小时，=0.004）与不良结局相关。74 例（70%）患者进行了手术减压。单因素和多因素分析显示，术前严重神经功能缺损（=0.005）和截瘫时间延长（>12 小时，=0.004）是独立的不良预后因素。单因素分析显示，下胸椎部位（=0.08）和快速进展（<6 小时，=0.005）与预后不良相关，但多因素分析未将其确定为独立的预后因素。
SSEH 的不良预后因素可能包括胸椎节段位置、抗凝治疗、入院时严重神经功能缺损、括约肌功能障碍和快速进展。在接受手术减压的患者亚组中，术前神经功能缺损和截瘫时间延长与预后密切相关。对于有中度/重度神经功能缺损或神经功能进行性恶化的患者，建议及时进行手术减压。
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