Rezvani Majid, Sabouri Masih, Aminmansour Bahram, Falahpour Soheil, Sourani Arman, Sharafi Mohammad, Baradaran Mahdavi Sadegh, Foroughi Mina, Nik Khah Roham, Sourani Armin, Veisi Shaahin
Department of Neurosurgery, School of Medicine.
Environment Research Center.
Ann Med Surg (Lond). 2023 Dec 8;86(1):612-619. doi: 10.1097/MS9.0000000000001604. eCollection 2024 Jan.
COVID-19 vaccination side effects are rare but important medical situations. Spine-affecting side effects are amongst the rarest, but exceedingly important. Haemorrhagic spinal manifestations of COVID-19 and its vaccines are less reported with little knowledge about them.
An 80-year-old male who received his first shot of the COVID-19 vaccine had developed COVID-19 pneumonia, weakness, and sensory problems in his legs followed by sphincter incontinence within 5 days period. MRI showed a spontaneous epidural spinal epidural haematoma (SSEDH) in T10-L1. He underwent laminectomy and haematoma evacuation. One month follow-up showed no clinical improvement.
To our knowledge, this was the first post-vaccination SSEDH and second in haemorrhagic spinal complications following COVID-19 vaccination. Considering the neuropathogenesis pathway of COVID-19 and its vaccines, there are common mechanisms of action that could potentially justify post-vaccination SSEDH such as seen in COVID-19 infection, itself. Early Neurosurgical intervention and better preoperative neurological status could be a beneficial modifier for favourable clinical outcomes.
SSEDH and COVID-19 vaccine coincidence is a rare clinical event, still no solid association could be scientifically explained. Further studies are required for a reliable pathophysiologic association. Early diagnosis, interdisciplinary medical approach, and faster intervention are the cornerstone of the treatment paradigm.
新冠病毒疫苗接种的副作用虽罕见，但属于重要的医学情况。影响脊柱的副作用最为罕见，但极其重要。新冠病毒及其疫苗导致的脊柱出血表现报道较少，人们对此了解甚少。
一名80岁男性接种了第一剂新冠病毒疫苗后，患上了新冠病毒肺炎，腿部出现无力和感觉问题，随后在5天内出现括约肌失禁。磁共振成像显示胸10至腰1节段出现自发性硬膜外脊髓血肿（SSEDH）。他接受了椎板切除术和血肿清除术。一个月的随访显示临床症状未改善。
据我们所知，这是首例接种疫苗后出现的SSEDH，也是新冠病毒疫苗接种后出血性脊柱并发症的第二例。考虑到新冠病毒及其疫苗的神经发病机制途径，存在一些共同的作用机制，这可能解释接种疫苗后出现SSEDH的原因，就像在新冠病毒感染本身中看到的那样。早期神经外科干预和更好的术前神经状态可能是获得良好临床结果的有益调节因素。
SSEDH与新冠病毒疫苗巧合是一种罕见的临床事件，目前尚无科学依据能解释其确切关联。需要进一步研究以明确可靠的病理生理关联。早期诊断、多学科医疗方法和更快的干预是治疗模式的基石。
