Nonsurgical treatment of an upper thoracic spinal subdural hemorrhage

Study design: A case report of an upper thoracic spinal subdural hemorrhage which was managed successfully by conservative treatment. Objectives: Spinal subdural hemorrhage is rare and can cause serious neurol ogic symptoms. Surgery is the most common treatment and is believed to prev ent further neurologic injury. A case of an upper thoracic spinal subdural hemorrhage which was managed successfully by conservative therapy is report ed. Setting: Department of Orthopaedic Surgery, Tokai University School of Medi cine, Isehara, Japan. Methods: A 29-year-old woman presented with acute severe back pain. She exp erienced acutely developed weakness of both lower extremities, hypesthesia below T6 and urinary retention. Magnetic resonance imaging performed on the day of hospital admission revealed the existence of a subdural hematoma in the upper thoracic spine. Muscle strength of the lower extremities was gra de 0 on admission, but improved slightly on day 1. The decision was made to manage the patient nonoperatively by corticosteroid and diuretic administr ation. Results: Improvement was gradual but progressive. Muscle strength was grade 4 out of 5 on the 28th day. Magnetic resonance imaging at 3 months except for mild urinary retention. Conclusions: Spinal subdural hemorrhage can be treated nonoperatively by co rrelating magnetic resonance image findings with the clinical condition.