He Chuan, Zhong Qi, Yang Ying, Cao Gang
Department of Neurosurgery, Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine (Zhuhai Hospital Affiliated to Faculty of Chinese Medicine, Macau University of Science and Technology) Zhuhai City, China.
Zhuhai Integrated Traditional Chinese and Western Medicine Hospital Gongbei Community Health Service Center, Zhuhai City, China.
Front Surg. 2025 Aug 14;12:1622953. doi: 10.3389/fsurg.2025.1622953. eCollection 2025.
Spinal cord hemorrhage (SCH), particularly involving the bulbar-cervical segment (medulla oblongata to C7), is a rare and life-threatening neurological emergency. Due to its anatomical proximity to respiratory, motor, and sensory centers, it often leads to catastrophic neurological deficits. Etiologies include vascular malformations, coagulopathy, or idiopathic causes, yet its low incidence (<1%) poses significant challenges in early diagnosis and management. Current evidence highlights emergency hematoma evacuation, adequate decompression, and spinal stabilization as critical for improving prognosis, though clinical validation through case-based data remains limited.
A 28-year-old male presented with acute dyspnea, limb numbness, and progressive weakness (left 1/5, right 2/5 on the Medical Research Council scale) over 2 h. Neurological examination revealed a sensory deficit below the T4 dermatome and bilateral pyramidal signs. Imaging confirmed a hematoma extending from the medulla oblongata to C7, with no evidence of vascular malformations or trauma. Emergency microscopic hematoma evacuation (8 ml) was performed, combined with posterior cervical double-door laminectomy (C3-C7) and pre-contoured rod pedicle screw fixation. Postoperatively, mechanical ventilation was discontinued within 24 h. Sensory levels regressed to T8, and motor function improved progressively (left 3+/5, right 5/5 at 2-month follow-up). Postoperative imaging confirmed complete hematoma resolution and stable instrumentation.
Bulbar-cervical SCH necessitates vigilant monitoring for cardiorespiratory compromise. Multidisciplinary emergency intervention-hematoma evacuation with decompression-effectively halts neurological deterioration. The dual-door laminectomy technique optimizes spinal canal expansion while preserving stability, providing a biomechanical foundation for neural recovery. This case underscores the pivotal role of early surgical decompression and stabilization in achieving favorable long-term outcomes for high-level SCH.
脊髓出血（SCH），尤其是累及延髓 - 颈段（延髓至C7）的脊髓出血，是一种罕见且危及生命的神经系统急症。由于其在解剖位置上与呼吸、运动和感觉中枢相邻，常导致灾难性的神经功能缺损。病因包括血管畸形、凝血功能障碍或特发性原因，但其低发病率（<1%）给早期诊断和治疗带来了重大挑战。目前的证据表明，紧急血肿清除、充分减压和脊柱稳定对于改善预后至关重要，尽管基于病例数据的临床验证仍然有限。
一名28岁男性在2小时内出现急性呼吸困难、肢体麻木和进行性无力（医学研究委员会肌力分级：左侧1/5，右侧2/5）。神经系统检查发现T4皮节以下感觉减退和双侧锥体束征。影像学检查证实血肿从延髓延伸至C7，无血管畸形或外伤证据。进行了紧急显微镜下血肿清除（8毫升），并结合颈椎后路双开门椎板切除术（C3 - C7）和预弯棒椎弓根螺钉固定。术后24小时内停止机械通气。感觉平面退至T8，运动功能逐渐改善（2个月随访时左侧3 + /5，右侧5/5）。术后影像学检查证实血肿完全清除且内固定稳定。
延髓 - 颈段脊髓出血需要密切监测心肺功能不全。多学科紧急干预——血肿清除减压——可有效阻止神经功能恶化。双开门椎板切除术技术在保持稳定性的同时优化了椎管扩大，为神经恢复提供了生物力学基础。本病例强调了早期手术减压和稳定在实现高位脊髓出血良好长期预后中的关键作用。
