Emergency Surgery ina a patient with large spontaneous epidurl hematoma determinig exellent neurological recovery: review of the literature

Abstract

Study Design: Case report Objectives: we report a case of a 75-year-old woman suffering voluminous idiopathic spontaneous spinal epidural hematomas (SSEH) that was rapidly diagnosed and successfully treated Methods: Clinical presentation was characterized by sudden and intense back pain that rapidly evolved into plegia of the right leg and severe paresis of the left leg. Hypoesthesia below T6 and urinary retention were also present. The MRI showed a significant posterior spinal compression from T6 through L3 caused by an epidural hematoma that involved 10 metameric levels, extending for approximately 20 cm, with a maximum thickness of 1.6 cm from T12 to L1. Results: Within 12 hours, emergency decompressive laminectomy from T10 to L1 was performed, and evacuation of the hematoma was achieved. The post-operative course and neurological recovery of the patient were optimal. After discharge, the patient continued the rehabilitative treatment started during hospitalization, achieving an excellent functional outcome in one month. Conclusions: Spinal epidural hematomas SEH are rare clinical findings that can occur following trauma or spontaneously (SSEH). We describe, to the best of our knowledge, the second most extensive idiopathic SSEH and the longest with involvement of the dorso-lumbar spine that had a excellent functional outcome due to emergency decompressive laminectomy which is emphasized in the treatment of these rare pathologies.