Spontaneous Spinal Epidural Hematoma: Correlation of Timing of Surgical Decompression and MRI Findings with Functional Neurological Outcome

OBJECTIVE: Spontaneous spinal epidural hematoma (SSEH) is a rare and morbid entity, with the prognosis affected by delayed diagnosis and surgical intervention. The correlation between the timing of the intervention and neurological recovery has not been clearly reported. We present a retrospective study of SSEH to determine the correlation between the timing of surgical intervention and changes in the spinal cord signal on magnetic resonance imaging (MRI) with the neurological outcome. METHODS: The records of 14 patients who had undergone surgical decompression of SSEHs during a 10-year duration were reviewed. The diagnosis was established from the MRI, intraoperative, and histopathological examination findings. RESULTS: We identified 14 patients from both centers, 6 of whom were male. Their mean age was 54.1 years. The onset was spontaneous, and 2 patients were receiving anticoagulant therapy. The most common presentation was paraplegia (n = 8), followed by paraparesis (n = 3) and quadriparesis (n = 2). Spinal cord signal changes were demonstrated on all T2-weighted MRI studies. The response to surgery was favorable for 13 of our patients at the 6-month follow-up examination. The spinal cord changes had persisted in 5 patients on the 6-month postoperative MRI scan. All 14 patients, except for 1, had a favorable neurological outcome at the last follow-up examination. CONCLUSIONS: Significant neurological recovery after surgical decompression of SSEHs can be achieved, despite the significant preoperative neurological deficits, spinal cord changes on MRI, and delayed timing of intervention.