Microsurgical treatment of spontaneous and non-spontaneous spinal epiduralhaematomas: Neurological outcome in relation to aetiology

Background. This retrospective study evaluated the neurological outcome of 26 patients with spontaneous and non-spontaneous spinal epidural haematoma (SEH) who underwent microsurgical clot removal. It was the objective of the present study to investigate whether the aetiology of the SEH has an influ ence on the neurological outcome. Methods. The medical records and radiological investigations of 26 patients with SEH were re-examined, and the latency between symptom onset and opera tion, and the size of the haematoma were determined. Motor and sensory func tion had been evaluated before surgery and 90 days after discharge. Findings. Fourteen patients with non-spontaneous SEH and 12 patients with s pontaneous SEH were identified. After surgery, neurological deficits improv ed in 9 of the patients with spontaneous (75%) and in 13 of the patients wi th non-spontaneous SEH (93%). In cases of spontaneous SEH, the median laten cy between symptom onset and operation was longer (72 hrs vs 7 hrs) and the median extent of the haematoma was larger (3.5 vs 2 spinal segments), than in the non-spontaneous cases. Interpretation. Neurological outcome seems to be related to the aetiology o f the SEH. Better outcome was observed in patients with surgically treated non-spontaneous SEH. Two explanations for this finding are worth considerin g. First, patients with non-spontaneous SEH usually are already under medic al surveillance and can undergo medullary decompression more rapidly. Secon d, the compression of the spinal cord is possibly less severe in non-sponta neous SEH because of their smaller size.