OPERATIVE TREATMENT OF SPONTANEOUS SPINAL EPIDURAL HEMATOMAS - A STUDY OF THE FACTORS DETERMINING POSTOPERATIVE OUTCOME

OBJECTIVE: We clarify the factors affecting postoperative outcomes in patients who have suffered spontaneous spinal epidural hematomas. METH ODS: We review 330 cases of spontaneous spinal epidural hematomas from the international literature and three unpublished cases of our own. Attention was focused on sex, age, medical history, mortality, size an d position of the hematoma, vertebral level of the hematoma, preoperat ive neurological condition, operative interval, and postoperative resu lt. RESULTS: Sex, age, and size and position of the hematoma did not c orrelate with postoperative outcome. Mortality correlated highly with cervical or cervicothoracic hematomas, especially in patients with car diovascular disease and those undergoing anticoagulant therapy. Incomp lete preoperative sensorimotor deficit correlated highly with favorabl e outcomes (P < 0.0005), and recovery was significantly better when de compression was performed in less than or equal to 36 hours in patient s with complete sensorimotor loss (P < 0.05) and in less than or equal to 48 hours in patients with incomplete sensorimotor deficit (P < 0.0 05). CONCLUSION: The critical factors for recovery after spontaneous s pinal epidural hematoma are the level of preoperative neurological def icit and the operative interval. The vertebral level of the hematoma d id not correlate with postoperative results, which suggests that local compression, rather than vascular obstruction, is the main factor in producing neurological deficit.