Patients with spontaneous spinal epidural hematoma, who have severe neurological deficit at the time of hospital admission are at greater risk of adverse outcomes, according to a recent study published in the journal Neurology.¹

A total of 105 patients, mean age 51.3 years, with spontaneous spinal epidural hematoma who had been hospitalized at three academic neurosurgery hospitals in Hangzhou in the Zhejiang province of China, from January 2010 to June 2021, were enrolled for this retrospective study. Information related to use of anticoagulants, imaging modality used, surgery performed and patient outcomes, including clinical status at the time of presentation using Frankel Scale, were sourced from the medical records of these participants. The objective of the study was to determine prognostic factors in these patients.

Twenty percent of patients had been administered anticoagulants; the incidence of acute onset of severe neck or back pain was 79%, while 78% patients had moderate to severe neurologic deficits corresponding to Grades A to C on the Frankel scale. Seventy percent patients underwent surgical decompression

Factors such as lower thoracic spine, use of anticoagulants, sphincter function dysfunction, severe neurologic deficits at admission and rapid progression (less than 1 hour) significantly correlated with adverse outcomes. Pre-operative severe neurologic deficits and extended paraplegia time of more than 12 hours were found to be independently associated with poor outcomes on univariate and multivariate analysis. Patients with rapid progression (less than 6 hours) and lower thoracic spine location were more likely to have poor prognosis on univariate analysis; however, this association lost significance on multivariate analysis.

This multicenter retrospective analysis sheds light on the “adverse prognostic factors” for spontaneous spinal epidural hematoma. It also underscores the significance of timing of surgical decompression and its impact on clinical outcomes. Among patients who underwent surgical decompression, preoperative neurological deficit and prolonged paraplegia were strongly correlated with the prognosis. The most important prognostic factor was the extent of neurologic deficit at the time of surgery. Hence, spontaneous spinal epidural hematoma patients with moderate or severe neurologic deficits or clinical/neurological deterioration should undergo surgical decompression urgently to improve functional outcomes.

Reference

1. Min Yan, et al. Prognostic factors and treatments efficacy in spontaneous spinal epidural hematoma: a multicenter retrospective study. Neurology. 2022 Jun 17;10.1212/WNL.0000000000200844. doi: 10.1212/WNL.0000000000200844.