SURGICAL-MANAGEMENT OF SPINAL EPIDURAL HEMATOMA - RELATIONSHIP BETWEEN SURGICAL TIMING AND NEUROLOGICAL OUTCOME

Thirty patients were treated surgically for spinal epidural hematoma ( SEH). Twelve of these cases resulted from spinal surgery, seven from e pidural catheters, four from vascular lesions, three from anticoagulat ion medications, two from trauma, and two from spontaneous causes. Pai n was the predominant initial symptom, and all patients developed neur ological deficits. Eight patients had complete motor and sensory loss (Frankel Grade A); six had complete motor loss but some sensation pres erved (Frankel Grade B); and 16 had incomplete loss of motor function (10 patients Frankel Grade C and six patients Frankel Grade D). The av erage interval from onset of initial symptom to maximum neurological d eficit was 13 hours, and the average interval from onset of symptom to surgery was 23 hours. Surgical evacuation of the hematoma was perform ed in all patients; 26 of these improved; four remained unchanged, and no patients worsened (mean follow up 11 months). Complete recovery (F rankel Grade E) was observed in 43% of the patients and functional rec overy (Frankel Grades D or E) was observed in 87%. One postoperative d eath occurred from a pulmonary embolus (surgical mortality 3%). Preope rative neurological status correlated with outcome; 83% of Frankel Gra de D patients recovered completely compared to 25% of Frankel Grade A patients. The rapidity of surgical intervention also correlated with o utcome; greater neurological recovery occurred as the interval from sy mptom onset to surgery decreased. Patients taken to surgery within 12 hours had better neurological outcomes than patients with identical pr eoperative Frankel grades whose surgery was delayed beyond 12 hours. T his large series of SEH demonstrates that rapid diagnosis and emergenc y surgical treatment maximize neurological recovery. However, patients with complete neurological lesions or long-standing compression can i mprove substantially with surgery.