Department of Neurosurgery, Ibn Tofail Hospital, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy in Marrakech, Cadi Ayyad University, Marrakech, Morocco.
Pan Afr Med J. 2022 Oct 4;43:55. doi: 10.11604/pamj.2022.43.55.36552. eCollection 2022.
Spontaneous spinal epidural hematomas are a rare consequence of long-term anticoagulant therapy. Their physiopathology remains poorly understood. This pathology carries a significant risk of morbidity. The purpose of this article is to report a case of a massive spontaneous spinal epidural hematoma extending on multiple levels, detailing the surgical technique used in its evacuation described for the first time in literature. This is a case report of an 80-year-old patient on anticoagulant therapy with a thoracolumbar spontaneous spinal epidural hematoma extending from T1 to L1 vertebrae. We share the clinical and radiological presentations, the surgical treatment, outcome and follow-up. The diagnosis of spontaneous spinal epidural hematoma has to be considered in patients with acute brutal onset radiculo-medullary compression. Medullary magnetic resonance imaging (MRI) remains the exam of choice. Medical and surgical treatment must be started immediately after the diagnosis is confirmed. The prognosis remains poor despite a proper management, with debilitating complications.
自发性脊柱硬膜外血肿是长期抗凝治疗的罕见后果。其病理生理学仍知之甚少。这种病理会带来严重的发病风险。本文的目的是报告一例广泛分布于多个节段的巨大自发性脊柱硬膜外血肿，详细介绍了首次在文献中描述的用于清除该血肿的手术技术。这是一例 80 岁老年患者，长期接受抗凝治疗，出现从 T1 到 L1 椎体的胸腰椎自发性脊柱硬膜外血肿。我们分享了该病例的临床表现、影像学表现、手术治疗、结果和随访情况。对于急性剧烈神经根-脊髓压迫的患者，应考虑自发性脊柱硬膜外血肿的诊断。脊髓磁共振成像（MRI）仍然是首选检查。一旦确诊，必须立即开始进行医学和手术治疗。尽管进行了适当的治疗，但预后仍然很差，会出现使人衰弱的并发症。
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