Spontaneous cervical epidural hematomas in mild cervical spondylotic myelopathy patients: An analysis of 8 cases

Spontaneous cervical epidural hematoms (SCEH) complicated with mild cervical spondylotic myelopathy (CSM) is a rare but emerging condition. Early diagnosis and treatment are important for good outcomes. This study aimed to investigate the clinical characteristics of this condition and to discuss the optimal treatment. The clinical data from 8 patients with SCEH plus CSM who were divided into two groups by treatment methods were retrospectively analyzed. The neurological function of the patients was assessed by Japanese Orthopedic Association (JOA) score before and after the surgical operations. Other factors were reviewed with medical records. Among them, 4 out of the 8 patients underwent emergency surgery, and the rest 3 patients experienced an initial conservative treatment and ultimately received a laminectomy. We found that the Frankel Scale scores in most of the surgical patients were increased after surgery (6/7, 85.7%). However, the JOA scores at the 6th month after onset were even lower than those before onset in 3 of the operative cases, and those in the patients who were given conservative treatment showed no significant change. It was concluded that some patients with SCEH and CSM treated with a timely operation may obtain relief from their previous CSM symptoms. However, the final neurological deficits of these patients were closely related to the progressive interval which refers to the hours between the initial onset and the occurrence of new neurological deficits or mild CSM deterioration, no matter whether they accept the operation. We found the crucial progressive interval may be in 9 h. Early MRI and prompt neurosurgical intervention are also important to improve the neurological deficits.