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Clinical Outcomes of Spontaneous Spinal Epidural Hematoma : A Comparative Study between Conservative and Surgical Treatment

OBJECTIVE: The incidence of spontaneous spinal epidural hematoma (SSEH) is rare. Patients with SSEH, however, present disabling neurologic deficits. Clinical outcomes are variable among patients. To evaluate the adequate treatment method according to initial patients' neurological status and cl...

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Autores principales: Kim, Tackeun, Lee, Chang-Hyun, Hyun, Seung-Jae, Yoon, Sang Hoon, Kim, Ki-Jeong, Kim, Hyun-Jib
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Neurosurgical Society 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3550419/
https://www.ncbi.nlm.nih.gov/pubmed/23346323
http://dx.doi.org/10.3340/jkns.2012.52.6.523
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author Kim, Tackeun
Lee, Chang-Hyun
Hyun, Seung-Jae
Yoon, Sang Hoon
Kim, Ki-Jeong
Kim, Hyun-Jib
author_facet Kim, Tackeun
Lee, Chang-Hyun
Hyun, Seung-Jae
Yoon, Sang Hoon
Kim, Ki-Jeong
Kim, Hyun-Jib
author_sort Kim, Tackeun
collection PubMed
description OBJECTIVE: The incidence of spontaneous spinal epidural hematoma (SSEH) is rare. Patients with SSEH, however, present disabling neurologic deficits. Clinical outcomes are variable among patients. To evaluate the adequate treatment method according to initial patients' neurological status and clinical outcome with comparison of variables affecting the clinical outcome. METHODS: We included 15 patients suffered from SSEH. Patients were divided into two groups by treatment method. Initial neurological status and clinical outcomes were assessed by the American Spinal Injury Association (ASIA) impairment scale. Also sagittal hematoma location and length of involved segment was analyzed with magnetic resonance images. Other factors such as age, sex, premorbid medication and duration of hospital stay were reviewed with medical records. Nonparametric statistical analysis and subgroup analysis were performed to overcome small sample size. RESULTS: Among fifteen patients, ten patients underwent decompressive surgery, and remaining five were treated with conservative therapy. Patients showed no different initial neurologic status between treatment groups. Initial neurologic status was strongly associated with neurological recovery (p=0.030). Factors that did not seem to affect clinical outcomes included : age, sex, length of the involved spinal segment, sagittal location of hematoma, premorbid medication of antiplatelets or anticoagulants, and treatment methods. CONCLUSION: For the management of SSEH, early decompressive surgery is usually recommended. However, conservative management can also be feasible in selective patients who present neurologic status as ASIA scale E or in whom early recovery of function has initiated with ASIA scale C or D.
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spelling pubmed-35504192013-01-23 Clinical Outcomes of Spontaneous Spinal Epidural Hematoma : A Comparative Study between Conservative and Surgical Treatment Kim, Tackeun Lee, Chang-Hyun Hyun, Seung-Jae Yoon, Sang Hoon Kim, Ki-Jeong Kim, Hyun-Jib J Korean Neurosurg Soc Clinical Article OBJECTIVE: The incidence of spontaneous spinal epidural hematoma (SSEH) is rare. Patients with SSEH, however, present disabling neurologic deficits. Clinical outcomes are variable among patients. To evaluate the adequate treatment method according to initial patients' neurological status and clinical outcome with comparison of variables affecting the clinical outcome. METHODS: We included 15 patients suffered from SSEH. Patients were divided into two groups by treatment method. Initial neurological status and clinical outcomes were assessed by the American Spinal Injury Association (ASIA) impairment scale. Also sagittal hematoma location and length of involved segment was analyzed with magnetic resonance images. Other factors such as age, sex, premorbid medication and duration of hospital stay were reviewed with medical records. Nonparametric statistical analysis and subgroup analysis were performed to overcome small sample size. RESULTS: Among fifteen patients, ten patients underwent decompressive surgery, and remaining five were treated with conservative therapy. Patients showed no different initial neurologic status between treatment groups. Initial neurologic status was strongly associated with neurological recovery (p=0.030). Factors that did not seem to affect clinical outcomes included : age, sex, length of the involved spinal segment, sagittal location of hematoma, premorbid medication of antiplatelets or anticoagulants, and treatment methods. CONCLUSION: For the management of SSEH, early decompressive surgery is usually recommended. However, conservative management can also be feasible in selective patients who present neurologic status as ASIA scale E or in whom early recovery of function has initiated with ASIA scale C or D. The Korean Neurosurgical Society 2012-12 2012-12-31 /pmc/articles/PMC3550419/ /pubmed/23346323 http://dx.doi.org/10.3340/jkns.2012.52.6.523 Text en Copyright © 2012 The Korean Neurosurgical Society http://creativecommons.org/licenses/by-nc/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Article
Kim, Tackeun
Lee, Chang-Hyun
Hyun, Seung-Jae
Yoon, Sang Hoon
Kim, Ki-Jeong
Kim, Hyun-Jib
Clinical Outcomes of Spontaneous Spinal Epidural Hematoma : A Comparative Study between Conservative and Surgical Treatment
title Clinical Outcomes of Spontaneous Spinal Epidural Hematoma : A Comparative Study between Conservative and Surgical Treatment
title_full Clinical Outcomes of Spontaneous Spinal Epidural Hematoma : A Comparative Study between Conservative and Surgical Treatment
title_fullStr Clinical Outcomes of Spontaneous Spinal Epidural Hematoma : A Comparative Study between Conservative and Surgical Treatment
title_full_unstemmed Clinical Outcomes of Spontaneous Spinal Epidural Hematoma : A Comparative Study between Conservative and Surgical Treatment
title_short Clinical Outcomes of Spontaneous Spinal Epidural Hematoma : A Comparative Study between Conservative and Surgical Treatment
title_sort clinical outcomes of spontaneous spinal epidural hematoma : a comparative study between conservative and surgical treatment
topic Clinical Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3550419/
https://www.ncbi.nlm.nih.gov/pubmed/23346323
http://dx.doi.org/10.3340/jkns.2012.52.6.523
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